Neal Shahidi1,2, Sunil Gupta1, and Michael J. Bourke1,2 1Westmead Clinical School University of Sydney, Sydney New South Wales, Australia 2University of British Columbia, Vancouver, British Columbia, Canada Endoscopic resection techniques have transformed the management of colorectal lesions, including diminutive (≤5 mm), small (6–9 mm), medium (10–19 mm), and large (≥20 mm) colorectal lesions. Herein, we demonstrate the application of various resection techniques including cold‐snare polypectomy (Figures 83.1 and 83.2), conventional polypectomy (Figure 83.3), endoscopic mucosal resection (EMR) (Figure 83.4), and endoscopic submucosal dissection (Figure 83.5). This includes the management of complex lesions, including those involving the ileocecal valve, appendiceal orifice, and anorectal junction (Figure 83.6), as well as lesions with nonlifting polypoid tissue (Figure 83.7). Moreover, we demonstrate the management of periprocedural adverse events, including clinically significant intraprocedural bleeding and deep mural injury (Figure 83.8), and delayed bleeding (Figure 83.9). Figure 83.1 Cold‐snare polypectomy. (a, b) A diminutive polyp in the transverse colon with optical features consistent with an adenomatous polyp. (c, d) Cold‐snare polypectomy. (e, f) Waterjet irrigation into the resection defect with subsequent expansion confirming successful cold‐snare polypectomy. Figure 83.2 Piecemeal cold‐snare polypectomy. (a) A 30 mm laterally spreading lesion with optical features consistent with a sessile serrated polyp in the ascending colon. (b, c) Piecemeal cold‐snare polypectomy facilitated by chromoinjectate. (d)
CHAPTER 83
Endoscopic management of colorectal lesions
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