A 45-year-old woman with chronic
liver disease and splenomegaly was admitted to our hospital for diagnostic
upper GI endoscopy. The endoscope revealed GII and GIII esophageal varices and
a small sessile protruded polyp at the pyloric region near the incisura (0 Is
according to Paris classification. Band ligation was done for the
esophageal varices. Two weeks after band ligation, the patient was admitted
again to the hospital for EMR of the gastric polyp.
Steps of EMR:
1-
Detection of the lesion.
2-
Localization of the lesion
3-
Identification of the lesion
4-
Flushing of the polyp with methylene blue was done to better
characterization and classification of the polyp.
5-
Washing of the dye was done using
normal saline.
6-
Injection of the submucosa with saline, adrenaline, and methylene blue
was done (begin from the caudal side of the polyp then the cephalad side.
7-
The suction of the elevated polyp with the band ligation apparatus was
done. Then band ligation of the polyp was done.
8-
By using an oval snare, the polyp was firmly held and slightly pushed
away from the gastric wall, the cutting f the polyp using diathermy was done.
9-
Retrieval of the excised polyp was done using foreign body biopsy.
10-
The size of the polyp was
estimated. It is put in formalin and was sent for histopathology.
N.B: there is an area of normal mucosa that is excised with the polyp.
The question here is: what we do is overtreatment and can we use a hot snare to
remove the polyp
Fig
(1): estimation of the polyp size
Fig(2):
the excised polyp
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