Post written by Yoko Kubosawa, MD, and Toshio Uraoka, MD, PhD, from the Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, and the Department of Gastroenterology, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
We report 2 cases of cold snare polypectomy for polyp extending into colonic diverticulum. Case 1 is a 6-mm-diameter flat adenoma adjacent to a diverticulum. The tip of a snare was stuck into the normal mucosa distal to the lesion. The left side of the snare hooked the lesion extending into a diverticulum, and en bloc resection was achieved. Case 2 is a 9-mm-diameter flat adenoma, which was also extending into a diverticulum. The tip of a snare was stuck into the diverticulum and careful snaring included the lesion extending into a diverticulum. Cold snare polypectomy achieved en bloc resection.
Colonic diverticula do not have a muscle layer. Therefore, endoscopic mucosal resection (EMR) for polyps adjacent to colonic diverticula has a high risk for perforation. The advantages of cold snare polypectomy over hot snare polypectomy include lower rates of post-polypectomy syndrome and delayed bleeding. So, we performed cold snare polypectomy for polyps extending into diverticula. We hope sharing this choice of method and technique will help other endoscopists who may face similar cases.
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