LARGE UPPER RECTAL POLYP IN ELDERLY PATIENT

By Monzur Ahmed

An 81 year old man presented with chronic diarrhoea but no rectal bleeding or weight loss. An index colonoscopy, performed by a colleague 4 weeks ago showed 4 polyps. Three of the smaller polyps (1-2cm) were removed from the transverse and descending colon and histology showed tubular adenoma with low grade dysplasia. The fourth polyp was about 6cm in diameter and located in the upper rectum behind a valve of Houston. This polyp was not biopsied and he was referred for a further procedure (see video). The video highlights:
- use of gastroscope to improve access in an awkwardly situated polyp
- using large volume of lift solution - working in retroflexion to clear the oral aspects of the polyp
- using Coagrasper to coagulate vessels on base
​- using APC to treat the edges of the defect