Post written by Satoki Shichijo, MD, PhD, from Osaka International Cancer Institute, Osaka, Japan.

We performed underwater EMR for a 20-mm Paris Ip polyp at the terminal ileum. The lumen of the terminal ileum was infused with normal saline through the waterjet of the colonoscope. This made the polyp float and permitted thorough inspection despite the limited maneuverability of the colonoscope.

Stalk ligation using an endoloop was facilitated with the underwater technique, and hot snare polypectomy was performed. Pathological diagnosis was intramucosal adenocarcinoma in a tubulovillous adenoma, 0-Ip, tub1, pTis, ly0, v0, HM0, VM0.

It was important to feature this video because the use of underwater EMR for small intestinal polyps remains limited, and its usefulness remains unknown.

Performing underwater EMR in the narrow lumen of the small intestine allows visualization and en bloc resection, resulting in a curative resection of adenocarcinoma in this patient.

Thank you for reading.

Magnified narrow-band imaging showed a tumor pattern at the top of the polyp.

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