Polypectomy, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Video Colonoscopic view of a polypectomy. Colonoscopy and polypectomy are the most effective tools available to prevent colorectal cancer. Removal of polyps is an important method of prevention and cure of cancer of the colon. Adenomatous polyps are precursors of most colorectal cancers, and their prevalence increases with age. The chance of detecting adenomatous polyps at colonoscopy is generally independent of the indication for the procedure The practice of removing polyps at colonoscopy is based on the assumption that their removal prevents progression to cancer. This concept, often called the adenoma-carcinoma sequence.

        Video Colonoscopic view of a Polypectomy.

 Colonoscopy and polypectomy are the most effective tools
 available to prevent colorectal cancer.

 Removal of polyps is an important method of prevention
 and cure of cancer of the colon.

 Adenomatous polyps are precursors of most colorectal
 cancers, and their prevalence increases with age. The
 chance of detecting adenomatous polyps at colonoscopy is
 generally independent of the indication for the procedure
 The practice of removing polyps at colonoscopy is based on
 the assumption that their removal prevents progression to
 cancer. This concept, often called the adenoma-carcinoma
 sequence.

 For more endoscopic details download the video clip by
 clicking on the endoscopic image, if you like to appreciate
 in full screen, wait to be downloaded complete, then press
 Alt and Enter, configure the Windows media in repeat is
 optimal.
 All endoscopic images shown in this Atlas contain video
 clips.                                      
 We recommended that any video clip of this atlas should be
 seen in full screen.
                                           Medline.
Rectal Stalked Polyp. This 41 year-old male who undergone a routine colonoscopy which detected this polyp. The success of colonoscopic polypectomy and surveillance depends on the identification and complete removal of the adenoma or adenomas.

Video Endoscopic Sequence 1 of 7.

Rectal Stalked Polyp.

 This 41 year-old male who undergone a routine colonoscopy which detected this polyp.

 The success of colonoscopic polypectomy and surveillance depends on the identification and complete removal of the adenoma or adenomas.

 
Endoscopic polypectomy with diathermic loop, Initially, gastrointestinal endoscopy represented a useful diagnostic tool for digestive tract diseases. Yet, ever since Wolff and Shinya) introduced endoscopic polypectomy in the 1970's, treatment of colorectal polyp has undergone a significant progress.

Video Endoscopic Sequence 2 of 7.

Removal of a Pedunculated Polyp.

Endoscopic polypectomy with diathermic loop.

 Initially, gastrointestinal endoscopy represented a useful
 diagnostic tool for digestive tract diseases. Yet, ever since
 Wolff and Shinya) introduced endoscopic polypectomy in
 the 1970’s, treatment of colorectal polyp has undergone a
 significant progress.

 
The snare loop is placed in the pedicle. Endoscopic snare resection using a monopolar diathermic polypectomy snare made of monofilament steel wire.

Video Endoscopic Sequence 3 of 7.

The snare loop is placed in the pedicle.

 Endoscopic snare resection using a monopolar diathermic
 polypectomy snare made of monofilament steel wire.

 
The remnants of the pedicle is being cauterized .

Video Endoscopic Sequence 4 of 7.

The remnants of the pedicle is being cauterized.

 
Dormia basket was used to retrieve the cut polyp.

Video Endoscopic Sequence 5 of 7.

Dormia basket was used to retrieve the cut polyp.

 
he image and the video clip show the dormia basket that it used to retrieve the cut polyp.

Video Endoscopic Sequence 6 of 7.

The image and the video clip show the dormia basket that it used to retrieve the cut polyp.

 
Argon plasma coagulators have been introduced to fulgurate large polyp remnants or for hemostasis with very positive results.

Video Endoscopic Sequence 7 of 7.

 Argon plasma coagulators have been introduced to
 fulgurate large polyp remnants or for hemostasis with very
 positive results.

 
Video Colonoscopic Polypectomy. A 43 year-old female, that has been presenting rectal bleeding for two months. Adenomatous polyp with a large and wide pedicle at sigmoid was found. A colonoscopy polypectomy was performed, first injecting the stalk with dilute epinephrine (1:10,000), and ligating devices such as a triclip and removed by transection of the stalk with a polypectomy snare.

Video Endoscopic Sequence 1 of 23.

 Video Colonoscopic Polypectomy.

 A 43 year-old female, that has been presenting rectal
 bleeding for two months.
 Adenomatous polyp with a large and wide pedicle at
 sigmoid was found.
 A colonoscopy polypectomy was performed, first injecting
 the stalk with dilute epinephrine (1:10,000) in dextrosa
 50%, and ligating devices such as a triclip and removed by
 transection of the stalk with a polypectomy snare.
 See the complete video endoscopic sequence.


                                         Medline.  
Another image of the polyp.

Video Endoscopic Sequence 2 of 23.

Another image of the polyp.

Colonic adenomas are typically asymptomatic and are most commonly found by means of endoscopic or radiologic imaging studies performed because of unrelated symptoms or for colorectal cancer screening. Since at least 25% of men and 15% of women who undergo colonoscopic screening by experienced endoscopists are found to have one or more adenomas, the cumulative burden of subsequent surveillance colonoscopy on the health care system is substantial.

                                         Medline.

Large and wide pedicle. This image and the video display the large and wide pedicle.

Video Endoscopic Sequence 3 of 23.

 This image and the video display the large and wide
 pedicle.
 
Chromoendoscopy using indigo carmine. This method helps to enhance the recognition of details and reveal the otherwise invisible changes of the mucosa.

Video Endoscopic Sequence 4 of 23.

 Chromoendoscopy using indigo carmine.
 This method helps to enhance the recognition of details and
 reveal the otherwise invisible changes of the mucosa.







                                          Medline.
Magnification colonoscopy.

Video Endoscopic Sequence 5 of 23

High Magnification Colonoscopy.
Chromoendoscopy with indigo carmine dye.

Video Endoscopic Sequence 6 of 23.

 Chromoendoscopy with indigo carmine dye.
 

 
Amebic Ulcer. In addition to the polyp, we found through colonoscopy some multiple amebic ulcers, as well as diverticulae in the sigmoid. An amebic ulcer was found at sigmoid; multiple tiny ulcers were seen in the rectum and the cecum.

Video Endoscopic Sequence 7 of 23.

Amebic Ulcer.

 In addition to the polyp, we found through colonoscopy
 some multiple amebic ulcers, as well as diverticulae in the
 sigmoid. An amebic ulcer was found at sigmoid; multiple
 tiny ulcers were seen in the rectum and the cecum.
   
In order to avoid an hemorrhage, we took prophylactic measures, such a dilution of adrenaline 2 cc with 1/10.000 was injected in the base of the wide pedicle; after that, two triclip were applied to the base of the pedicle.

Video Endoscopic Sequence 8 of 23.

 In order to avoid an hemorrhage, we took prophylactic
 measures, such a dilution of adrenaline 2 cc with 1/10.000
 was injected in the base of the wide pedicle; after that, two
 triclip were applied to the base of the pedicle. 

To reduce the risk of postpolypectomy bleeding. Most pedunculated polyps are removed by transection of the stalk with a polypectomy snare. The major risk with this approach is postpolypectomy bleeding. As a result, many endoscopists use one or more methods to reduce the risk of bleeding, particularly in polyps with wide stalks (pedicles larger than 1 to 1.5 cm in diameter).

Video Endoscopic Sequence 9 of 23.

 Most pedunculated polyps are removed by transection of
 the stalk with a polypectomy snare. The major risk with this
 approach is postpolypectomy bleeding. As a result, many
 endoscopists use one or more methods to reduce the risk of
 bleeding, particularly in polyps with wide stalks (pedicles
 larger than 1 to 1.5 cm in diameter).

 

 
Note the white color that has been changed due to the injected dilution of adrenaline. (Vasoconstriction). It is considerably easier to snare polyps in the six o'clock position because the snare enters the field roughly at this orientation. The snare can be positioned over the polyp, which is subsequently captured by deflecting the tip of the colonoscope down.

Video Endoscopic Sequence 10 of 23.

 Note the white color that has been changed due to the
 injected dilution of adrenaline. (Vasoconstriction).

 It is considerably easier to snare polyps in the "six o'clock
 position" because the snare enters the field roughly at this
 orientation. The snare can be positioned over the polyp,
 which is subsequently captured by deflecting the tip of the
 colonoscope down.

 
The image and the video show the triclip. The principle of clip ligation for pedunculated polyps prior to polypectomy to stop bleeding or as a prophylactic measure to prevent bleeding.

Video Endoscopic Sequence 11 of 23.

 The TriClip´s

 (Endoscopic Clipping Device).

 The image and the video show the triclip.

 The principle of clip ligation for pedunculated polyps prior
 to polypectomy to stop bleeding or as a prophylactic
 measure to prevent bleeding.
The firs triclip was applied. Metallic hemoclips have been endoscopically placed in the gastrointestinal tract for the treatment of bleeding lesions and closure of perforation. A further potential application is the ligation of the pedunculated polyps prior to polypectomy as a prophylactic measure to prevent bleeding.

Video Endoscopic Sequence 12 of 23.

Endoscopic clip application, The first triclip was applied.

 Metallic hemoclips have been endoscopically placed in the
 gastrointestinal tract for the treatment of bleeding lesions
 and closure of perforation. A further potential application
 is the ligation of the pedunculated polyps prior to
 polypectomy as a prophylactic measure to prevent
 bleeding.

 
Two triclips were a pplied to the base of the pedicle.

Video Endoscopic Sequence 13 of 23.

 The second triclip is being applied to the base of the
 pedicle.

Two triclips were a pplied to the base of the pedicle. Ligation using suture or metallic clips is a basic surgical technique to prevent postoperative bleeding. Generally, there are nourish blood vessels in the stalk of the pedunculated polyp, and their diameter depend on the size of the polyp and the diameter of the stalk. It is essential to completely ligate the vessels or to prevent postoperative bleeding for pedunculated polyp with or without active bleeding.

Video Endoscopic Sequence 14 of 23.

 Two triclips were applied to the base of the pedicle.

 Ligation using suture or metallic clips is a basic surgical
 technique to prevent postoperative bleeding. Generally,
 there are nourish blood vessels in the stalk of the
 pedunculated polyp, and their diameter depend on the size
 of the polyp and the diameter of the stalk. It is essential to
 completely ligate the vessels or to prevent postoperative
 bleeding for pedunculated polyp with or without active
 bleeding. 
The two triclips are observed in the base of the wide pedicle.

Video Endoscopic Sequence 15 of 23.

 The two triclips are observed in the base of the wide
 pedicle.
 
Transection of the stalk with a polypectomy snare.

Video Endoscopic Sequence 16 of 23.

 Transection of the stalk with a polypectomy snare.

 
Note the traction used to avoid transmural injuries.

Video Endoscopic Sequence 17 of 23.

 Note the traction used to avoid transmural injuries.

 
The polyps have been falled out. the amebic ulcer is observed.

Video Endoscopic Sequence 18 of 23.

 The polyps have been falled out; the amebic ulcer is
 observed.
Only complete excision permits accurate histological diagnosis. As a result, polypectomy should be considered as primarily a diagnostic procedure until histopathology confirms that the polyp has been completely removed.

Video Endoscopic Sequence 19 of 23.

 Only complete excision permits accurate histological
 diagnosis. As a result, polypectomy should be considered
 as primarily a diagnostic procedure until histopathology
 confirms that the polyp has been completely removed.

 
The resection site should be closely inspected for visible vessels.

Video Endoscopic Sequence 20 of 23.

 The resection site should be closely inspected for visible
 vessels.

 
Histopathologic image. This is the picture of a villous adenoma which shows some This is the picture of a villous adenoma which shows some.

Video Endoscopic Sequence 21 of 23.

 Histopathologic Image.

 This is the picture of a villous adenoma which shows some
 mild epithelial atypia.

 
Colonic mucosae at the base of the polyp with mild chronic inflamation.

Video Endoscopic Sequence 22 of 23.

Colonic mucosa at the base of the polyp with mild chronic inflamation.

 
Immunohistochemic stain for p53 positive in some of the nuclei of the polyp.

Video Endoscopic Sequence 23 of 23.

Immunohistochemic stain for p53 positive in some of the nuclei of the polyp.

 
Polypectomy of stalked polyp. Polyps with a large pedicle at the descending colon. This 58 year old male who undergone a colonoscopy as a medical control, in the same colonoscopy the polyp was snared. The histopathologic study displayed tubulovillous adenoma with dysplasia.

Video Endoscopic Sequence 1 of 6.

Polypectomy of stalked polyp.

 Polyps with a large pedicle at the descending colon.

 This 58 year old male who undergone a colonoscopy as a
 medical control, in the same colonoscopy the polyp was
 snared .
 The histopathologic study displayed tubulovillous adenoma
 with dysplasia.

 
The form of the pedicle is observed.

Video Endoscopic Sequence 2 of 6.

The form of the pedicle is observed.

 
With the polypectomy snare the polyp is fragmented.

Video Endoscopic Sequence 3 of 6.

With the polypectomy snare the polyp is fragmented.
We continued with the technique of polypectomy in fragments.

Video Endoscopic Sequence 4 of 6.

 We continued with the technique of polypectomy in
 fragments.

 
More fragments.

Video Endoscopic Sequence 5 of 6.

More fragments.
The final status of the endoscopic polypectomy is observed

Video Endoscopic Sequence 6 of 6.

The final status of the endoscopic polypectomy is observed.
Video Colonoscopic view of a polypectomy of a big 6 cm. x 4 cm. sessile lesion.

Video Endoscopic Sequence 1 of 4.

 Video Colonoscopic view of a polypectomy of a big
 6 cm. x 4 cm. sessile lesion.
 The pictures showed below are the sequence of the
 removal.



                                         Medline.
Note the traction which the enormous lesion is being removed.

Video Endoscopic Sequence 2 of 4.

 Note the traction is being performed when the enormous
 lesion is being removed.
 






                                           Medline.
Status Post Videoendoscopic polypectomy of a huge sessile adenoma. The video clip displays the bleeding and cauterization.

Video Endoscopic Sequence 3 of 4.

 Status Post Videoendoscopic polypectomy of a huge sessile
 adenoma. The video clip displays the bleeding and
 cauterization.






                                           Medline.
Post status of polypectomy. 8 days after the endoscopic procedure, The ulcer is already healing.

Video Endoscopic Sequence 4 of 4.

Status Post Polypectomy.

 8 days after the endoscopic procedure, The ulcer is
 already healing.

        
Enormous sessile adenoma of the rectum. The primary clinical importance of colorectal adenomas is their well-recognized relationship to colorectal cancer. An abundance of scientific data indicate that almost all colorectal cancers arise from previous benign adenomas. Compelling evidence for this polyp-cancer sequence includes their similar prevalence in different world populations, their common etiology, and their similar site distribution in the colon.

Video Endoscopic Sequence 1 of 2.

Enormous Sessile Adenoma of the Rectum.

 The primary clinical importance of colorectal adenomas is
 their well-recognized relationship to colorectal cancer. An
 abundance of scientific data indicate that almost all
 colorectal cancers arise from previous benign adenomas.
 Compelling evidence for this polyp-cancer sequence
 includes their similar prevalence in different world
 populations, their common etiology, and their similar site
 distribution in the colon.
  

This tumor was removed completely with the snare polypectomy. The procedure was carried out in three different days with piecemeal excision.

Video Endoscopic Sequence 2 of 2.

 This tumor was removed completely with the snare
 polypectomy. The procedure was carried out in three
 different days with piecemeal excision.  

Polypectomy of a stalked polyp.

Polypectomy of a stalked polyp.

 
Endoscopic polypectomy. An attempt should be made to bring all polyps into the six o'clock position to facilitate snare placement, and this can usually be accomplished by rotation of the colonoscope relative to the polyp.

Video Endoscopic Sequence 1 of 2.

Endoscopic polypectomy.

 An attempt should be made to bring all polyps into the six
 o'clock position to facilitate snare placement, and this can
 usually be accomplished by rotation of the colonoscope
 relative to the polyp.

 
The polyp has been fallen out.

Video Endoscopic Sequence 2 of 2.

 The polyp has been fallen out.
Endoscopic snare excision of large pediculated polyp. This sequence displays a polypectomy of long stalked Polyps at the transverse colon near splecnic flexure.

Video Endoscopic Sequence 1 of 5.

 Endoscopic snare excision of large pediculated polyp.
 This sequence displays a polypectomy of long stalked
 Polyps at the transverse colon near splecnic flexure.

 
Placement of a snare wire over the stalk of the polyp.

Video Endoscopic Sequence 2 of 5.


 Placement of a snare wire over the stalk of the polyp.

 

 
Cautery is applied to the wire loop, which was tightened around the stalk of the polyp.

Video Endoscopic Sequence 3 of 5.

 Cautery is applied to the wire loop, which was tightened
 around the stalk of the polyp.

 

 
The video clip displays the cutting of the polyp.

Video Endoscopic Sequence 4 of 5.

 The video clip displays the cutting of the polyp.
 

 
Snaring the stalk.

Video Endoscopic Sequence 5 of 5.

 Snaring the stalk.
The image and the video clip display a diminutive polyp that was removed with coagulation, using argon plasma coagulator (APC). Small sessile polyps are resected, using several different techniques, including hot and cold biopsy (with and without cautery), hot or cold minisnare, or cold biopsy followed by fulgeration with a monopolar or bipolar electrode. The monopolar hot biopsy forceps should be used with great caution in the thin-walled right colon. There have been reported perforations and a relatively high rate of delayed bleeding using this device. When using any type of cautery probe in the right colon, it is important to apply low-power cautery cautiously without pressing the tip of the probe into the bowel wall. Even modest pressure can thin out the wall and increase the chance of perforation.

Argon Beam Coagulation

 The image and the video clip display a diminutive polyp
 that was removed with coagulation, using argon plasma
 coagulator (APC).
 Small sessile polyps are resected, using several different
 techniques, including hot and cold biopsy (with and without
 cautery), hot or cold minisnare, or cold biopsy followed by
 fulgeration with a monopolar or bipolar electrode. The
 monopolar hot biopsy forceps should be used with great
 caution in the thin-walled right colon. There have been
 reported perforations and a relatively high rate of delayed
 bleeding using this device. When using any type of cautery
 probe in the right colon, it is important to apply low-power
 cautery cautiously without pressing the tip of the probe into
 the bowel wall. Even modest pressure can thin out the wall
 and increase the chance of perforation.
 
Video Colonoscopic Polypectomy. A 55 year-old female, in a routine check-up, this mass was found at descending colon.

Video Endoscopic Sequence 1 of 29.

 Video Colonoscopic Polypectomy.

 A 55 year-old female, in a routine check-up, this mass was
 found at descending colon.

 Adenomatous tumor with a large and wide pedicle at
 descending was found. On the left lateral decubitus
 position, the tumor was thought to be sessile..
 A colonoscopy polypectomy was performed, first injecting
 the stalk with dilute epinephrine (1:10,000), and ligating
 devices such as a hemoclips and removed by transection of
 the stalk with a polypectomy snare.

 See the complete video endoscopic sequence.
PolipFeerrCut2

Video Endoscopic Sequence 2 of 29.

Large multilobulated tumor is displayed.

The long stalk of the polyp was exposed by rotating the colonoscope?s position.

Video Endoscopic Sequence 3 of 29.

 The long stalk of the polyp was exposed by rotating the
 colonoscope’s position.

 

 
PolipFeerrCut4

Video Endoscopic Sequence 4 of 29.

A large and wide pedicle.
A dilution of adrenaline with 1/10.000 was injected in the base of the wide pedicle.

Video Endoscopic Sequence 5 of 29.

 A dilution of adrenaline with 1/10.000 in dextrosa 50% was
 injected in the base of the wide pedicle.
Again more dilute epinephrine (1:10,000) such as used in the mucosectomy is performed.

Video Endoscopic Sequence 6 of 29.

Again more dilute epinephrine (1:10,000) such as used in the mucosectomy is performed.
The tumor became ischemic, indicating that the blood supply of the tumor had vasoconstriction adequately.

Video Endoscopic Sequence 7 of 29.

 The tumor became ischemic, indicating that the blood
 supply of the tumor had vasoconstriction adequately.
PolipFeerrCut8