By Toyooki Sonoda
This e-book presents surgeons and gastroenterologists with state of the art recommendations when it comes to complex colonoscopy. Chapters introduce tools of elimination polyps that weren't formerly amenable to colonoscopic snare polypectomy. complex recommendations resembling closure of perforations and intestinal stenting are generally coated. The textual content continues a powerful emphasis on surgical/endoscopic strategy. broad dialogue on gear and ability acquisition can also be lined. As many readers won't ever have obvious those complicated techniques earlier than, wide photos and movies are supplied. The authors supply assistance, methods, and pitfalls that might support the reader comprise those new recommendations into their practice.
Advanced Colonoscopy: Polypectomy and past should be of serious worth to any doctor or gastroenterologist at present acting colonoscopy and attracted to complex techniques.
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Additional resources for Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy
In Japan, most operators move up from gastric ESD to colorectal ESD. Experience in upper GI ESD is helpful and preferable but is not mandatory. Pitfalls In order to choose the appropriate case for ESD and to develop a strategy for dissection, it is imperative to gain experience with respect to image training during preoperative colonoscopy. Important items to be noted include not only morphology, size, and lesion location but also circumference, position of the folds in relation to the lesion, presence or absence of paradoxical endoscope movement, maneuverability of the scope, and the availability of a retroflex view.
Depressed polyps are a real challenge for conventional techniques. 3. Location: Polyps sitting in a flexure, or around a turn in the sigmoid colon, are often difficult to access with endoscopic instruments. If the colon is mobile, the fold can slip away from the scope. If the colon contracts or spasms, the polyp may be lost to sight. Polyps on the backside of a haustral fold, or polyps that are draped over a fold, are difficult because parts of the lesion are invisible and hard to access. Polyps on the ileocecal valve can be difficult to separate from the prolapsing ileal mucosa of the valve, while the fold of the valve itself is thicker and more stable than a haustral fold.
005 %. CO2 Gas Regulator (UCR; Olympus Medical Systems, Tokyo, Japan) The use of a carbon dioxide (CO2) insufflation system has made it easier to perform colorectal ESD. CO2 is absorbed by the tissues at a speed of more than 100 times that of room air. The use of this system can decrease colonic distension during ESD compared to air insufflation. In addition, even when perforation occurs and the hole is closed with a clip, the risk of peritonitis is remarkably decreased by CO2. Therefore, CO2 insufflation instead of air insufflation is our preferred method for a safer ESD and at the same time for reducing patient discomfort .
Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy by Toyooki Sonoda