Basic Polypectomy Course : Case 2
Case of Multiple Cold Snare Polypectomies and a Large Sigmoid Pedunculated Polyp. Performed by trainees with performance enhancing feedback and debrief.

In brief

This video emphasized the importance of accurate use and snare positioning during procedures. Utilizing visualization techniques, such as the 'underwater' method, and conducting post-procedure review to identify areas for improvement were discussed. Moreover, it underscores the significance of teamwork and effective communication in conducting successful polypectomy. This learning aims to improve practice and enhance patient outcomes in future procedures.

Detailed Summary

Here is a list of key learning points from the video:
  • Proper Snare Closure: The conversation stressed the importance of proper snare manipulation during procedures. One specific instruction discussed was ensuring all the polyp margins and a rim of normal tissue remain closed inside the snare.
  • Techniques for Snare Manipulation: Detailed explanations were given on techniques for positioning the snare correctly, specifically involving push-pull movements. It was emphasized that understanding how to maneuver the snare is crucial to the procedure's success.
  • Importance of Precise Snare Positioning: The video highlighted the importance of getting the snare into the correct “6 o’clock” position relative to the polyp.
  • Accurate Evaluation Post-Polypectomy: This step needs to be executed precisely to prevent incomplete procedures.
  • The Role of Visualization Techniques: The underwater visualization was suggested to enhance assessment of the polyp and the defect.
  • Endoloop Positioning: Correct positioning of the endoloop plays a crucial role in successful pedunculated polyp polypectomy.
  • Value of Continuous Learning and Improvement: The video underscored the need for ongoing learning to improve practice and outcomes.
  • Necessity of Post-Procedural Review: The video affirmed the need for post-procedure review and discussion to identify areas of improvement and consolidate learning.
  • Effective Teamwork and Communication: The video implied the importance of clear communication and collaboration between team members during medical procedures.

 

Tags
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Anatomy
Caecum
Decision making in Polypectomy
4 Ps - PositionChoice of snare typeHot versus cold snare polypectomy
Deconstructed Cold Snare Polypectomy
Cold Snare ProtrusionDefect inspection after CSPEndoscope positioningPiecemeal CSPSnare placementSnare selectionUse of submucosal injectionWide margin principle
Deconstructed Polypectomy Technique
Injection techniquePost polypectomy defect assessment
Imaging modalities
Underwater Imaging Using a Transparent Cap
JNET Classification
JNET 2A
Paris Classification
Paris 0-IIaParis 0-IpParis 0-Is
Pedunculated Polypectomy
Gravity to improve stalk accessMechanical ligation - nylon polyloopPlacement of a polyloopPlacement of snare over the stalk
Polyp Size
Small (less than 10mm)
Polypectomy
AssessmentCold Snare
Polypectomy technique
Cold Snare PolypectomyHot snare polypectomy without lifting
Resection
EndoLoop
Submucosal Injection Technique
Dynamic injectionStab and pull back to find submucosal plane
Training
Assessment of Trainee
Visualisation
Caecum (landmarks)Patient PositionRetroversion right colon
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References

1 - Nutalapati V, Desai M, Rastogi A. Effect of dynamic position changes on adenoma detection rate during colonoscope withdrawal: systematic review and meta-analysis. Endoscopy international open, 2020 vol. 8(12) pp. E1842-E1849. Visualisation / Patient Position

2 - IJspeert JE, Bastiaansen BA, . Development and validation of the WASP classification system for optical diagnosis of adenomas, hyperplastic polyps and sessile serrated adenomas/polyps. Gut, 2016 vol. 65(6) pp. 963-70. Polypectomy / Assessment

3 - Hewett DG, Kaltenbach T, Rex DK. Validation of a simple classification system for endoscopic diagnosis of small colorectal polyps using narrow-band imaging. Gastroenterology, 2012 vol. 143(3) pp. 599-607.e1. 10.1053/j.gastro.2012.05.006.Polypectomy / Assessment

4 - Desomer L, Tate DJ, Bourke MJ. A systematic description of the post-EMR defect to identify risk factors for clinically significant post-EMR bleeding in the colon. Gastrointestinal endoscopy, 2019 vol. 89(3) pp. 614-624. 10.1016/j.gie.2018.11.023.Deconstructed Polypectomy Technique / Post polypectomy defect assessment

5 - Soetikno R, Kaltenbach T, Kaltenbach T. Dynamic submucosal injection technique. Gastrointestinal endoscopy clinics of North America, 2010 vol. 20(3) pp. 497-502. Submucosal Injection Technique / Dynamic injection