Transverse colon EMR - Prior failed and incomplete resection
Patient: A middle aged woman with a family history of colon cancer underwent screening colonoscopy; a flat lesion in the transverse colon was incompletely resected. She was referred for a second opinion for endoscopic resection. Plan: Waited for 6 months for the area to heal.
Preparation: Split dose preparation.
Sedation: Conscious sedation, with the patient awake during the injection phase to control breathing.
Endoscope: Cap fitted pediatric colonoscope and CO2.
Injection: Indigo Carmine injection on the proximal side - away from the scar; single large injection of 15 ml.
Snare resection: 10 mm stiff snare; tight squeeze of snare; EndoCut.
Resection: Base blue and edges clean.
APC: Edges treated with APC to prevent recurrence.
Clip closure: 4 clips.
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