Video Endoscopic Sequence 1 of 20.

Prolasep Rectal adenocarcinoma resected with endoscopic endoresection

A 52-year-old female who for for the previous ten months had presented with a prolapsed mass.

Despite the fact that colorectal polyps and solitary rectal ulcers may be present in conjunction with rectal prolapse, association between rectal prolapse and rectal cancer is very rare.

All endoscopic images in this Atlas contain a video, which can be downloaded to your slide and used in academic presentations.

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Another image and video of the mass prolapsed through the anus.

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Ten days after her first apoiment, an endoscopic resection was performed. The biopsies following this resection revealed: adenocarcinoma originating from a tubulovillous polyp. With (Multiple foci of adenocarcinoma).

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Another image and video clip of the endoresection

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The image and video clip were obtained with an extra video camera; three large fragments of the tumor resected with a diathermy loop can be seen.

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The second fragment of the tumor is visible.

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The third fragment of the tumor is visible.

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Retroflexed image

A multilobulated mass is observed; this image and video clip are from before the start of the endoscopic endoresection.

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The mass is observed through the anal canal.

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Endoscopic endoresection using a diathermy loop

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Endoscopic Resection of Rectal Neoplasia.

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Endoscopic Resection of Rectal Neoplasia.

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Twenty days after the first endoscopic resection, a new therapeutic colonoscopy is performed.

The status after endoscopic endoresection is observed; there are some fragments of adenomas and scars. Small fragments are then resected.

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Saline solution is infiltrated into the residual fragments

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Residual fragments of adenomatous tissue are resected using a diathermy loop.

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Continue to dry the remaining fragments with a diathermy loop.

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More fragments have been resected

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Argon Plasma Coagulator is used to cauterize any remaining cells.

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Final status of endoscopic endoresection of a rectal adenocarcinoma

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Final status of endoscopic endoresection of a rectal adenocarcinoma

Endoscopic polypectomy.

Colonoscopy and endoscopic polypectomy are the most powerful tools for preventing colon carcinoma.

Video Endoscopic Sequence 1 of 8.

Polypectomy of Pedunculated Rectal Polyp

This 41-year-old male patient was found to have this polyp during a routine colonoscopy.

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The polypectomy is performed using a diathermy loop.

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Two years later a new colonoscopy was performed, revealing the scar of the polypectomy.

Video Endoscopic Sequence 1 of 23.

A 43-year-old female patient presented with rectal bleeding of approximately three months. A colonoscopy revealed an adenomatous polyp approximately two centimeters in size with a long, wide pedicle.
It was removed via endoscopic polypectomy.

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Another image of such a mass.

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The pedicle is observed to be large and wide

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The image and video show it being observed with chromatoscopy using indigo carmine.

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This image and video show a colonoscope with magnification.

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Another image using chromatoscopy

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Amoebic Ulcer..

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Infiltration with adrenaline in saline solution at 1/10.000

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Infiltration with adrenaline in saline solution at
1/10.000

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After the infiltrates,the stalk turns white.

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A triclip is applied to the stalk.

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The two triclips are visible on the pedicle

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Endoscopic polypectomy with a diathermy loop

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Polypectomy of a smal pedunculated polyp

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Endoscopic polypectomy.
The snare captures the polyp.

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Removing the remaining pedicle.

Polypectomy using argon plasma coagulation

Use of argon plasma coagulator in the removal of the tiny polyp.

Video Endoscopic Sequence 1 of 29

Endoscopic polypectomy of a large pedunculated mass.

A 55-year-old female patient was found to have this mass during a routine medical check-up.

Watch this video on YouTube

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A multilobed mass with a long and wide pedicle is seen.

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Another image of the multilobed mass

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La imagen y el video muestran el pédiculo largo y ancho.

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Infiltration with adrenaline at 1/10,000 in 50% dextrose.

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More applications of adrenaline dilution for vasoconstrictor effects.

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Note the color changes of the mass due to the vasoconstriction effect.

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Two hemoclips are applied to the pedicle..

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Application of the second hemoclip.

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After hemostatic measures, endoscopic polypectomy with a diathermy loop is initiated..

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These sequences show the cutting effect of the pedicle with the diathermy loop.

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The polyp must be moved to avoid thermal burns to the contralateral intestinal wall.

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The tumor has already been cut out but it has not completely detached.

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Again, using diathermy loop, they try to remove it once more.

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Having detached, the remnant of the pedicle with the two hemoclips can be seen.

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The mass is observed through remnants of secretions.

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Photographs of the cut mass.
Multinodulated polypoid tumor measuring 4 x 1.5 x 1.5 cm..

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Otra imágenes de la masa.

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Multilobulated tumor with focal areas of ulceration.

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More images of the multilobed mass.

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Más imágenes de la masa multilobulada.

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Tubulovellous adenoma of the descending colon.

Normal colonic mucosa is visible at the base of the polyp.

Under the microscope, it is a tubulovillous neoplasm of colonic mucosa with fibrous stroma; there are superficial ulcerated areas; the pedicle has normal muscularis mucosae and colonic mucosa; no atypia or malignancy was found.

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Tubulovillous pattern at low magnification.

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Tubulovillous pattern with vascular connective tissue axis.

Video Endoscopic Sequence 1 of 35.

Endoscopic Resection of Giant Tubulovillous Adenoma.

This is the case of a 57-year-old lady who had been experiencing rectal bleeding during six months and had only been prescribed ointments and suppositories. She was referred to our unit for evaluation. Anoscopy revealed a mass that initially appeared small, but a rectal examination showed it could be prolapsed through the anal canal. We immediately prepared her with potent laxatives for a colonoscopy and polypectomy.

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After administering oral laxatives, we decided to examine him and remove the tumor endoscopically

Large polyps are indeed associated with a higher rate of complications. Some polyps require surgical removal; the best indicator of whether a particular endoscopist should attempt removal is their level of experience and how confident they are in their skill and expertise.

One should not assume that because one's own comfort level is exceeded, this surgery is necessarily a mandate, in which case, the endoscopist should be prepared to consult with a more experienced colleague or consider referring the patient to another center.

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Upon performing retroflexion in the rectum, a large mass is observed that appears to be adenocarcinoma.

At this time we had no pathology results since we decided to remove this neoplasm which we initially thought was small but had a soft appearance.

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Another image of the irregularly shaped mass

Which patients should initially be treated with surgical resection?

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Since the initial plan was to remove the tumor, which appeared small, we dared to perform a fragmented polypectomy because we did not have any biopsy reported by pathology.

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When looping the diathermy loop, the large fragment prolapses to the outside and we perform polypectomy of this fragment outside the anal margin.

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Multiple fragments of the neoplasm with a hairy appearance are observed.

Note: In this endoscopic resection of this tumor, we did not use any injected fluid to lift the mucosa because the rectal walls are quite thick and there is no danger of perforation as could happen in the rest of the colon.

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Another image and video observing the infiltrative-looking fragments.

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Then we removed another large fragment

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Active bleeding is observed

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To stop this bleeding using the argon plasma, stopping the bleeding.

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Continuing to resect the neoplasm by removing several remnants with the diathermy loop.

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More fragments are being resected with the diathermy loop

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Some fragments are attached to the pectinate line; we continue using the diathermy loop to cut these fragments with cautery. In this anatomical region, care must be taken when performing endoscopic polypectomy due to the pain that cautery can cause in the anal tissue.

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Fragments of this giant tubulo villous adenoma continue to be resected in the pectineal line.

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Continuing with the polypectomy of large fragments, retroflexion maneuver.

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his image and video clip show that the tumor has almost completely Excised.

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TAnother large fragment.

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The fragment is placed in the formalin container.

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View after endoscopic resection of the tumor

This image and video clip show the status of the endoscopic resection of this giant tubulovillous tumor of the rectum.

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Cauterization is applied with argon plasma coagulator of micro remnants and hemostasis is performed.

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Final status of endoscopic resection.

Two weeks later, a new endoscopy is performed, see below.

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Photograph of some of the fragments

Macroscopic details of the excised tumor show a hairy appearance with a dark red surface.

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Base of the polyp with vascular connective tissue and thermal effects

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Panoramic view of the tubulovillous pattern.

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Detail with greater increase in hair size.

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High magnification detail of cellular atypia.

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The polyp mucosa and submucosa with the muscularis mucosae can be seen.

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Follow-up endoscopy two weeks after endoscopic resection of the tumor, tissue in the healing phase is observed, multiple biopsies were taken demonstrating only granulation tissue.

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Final stage of healing.

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Front view of the scar.

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Reinforcing with the argon plasma coagulation therapy in case there are any remnants of adenomatous tissue.

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Continuing with ablative therapy.

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