How to attack ? or abort?
This lesion was found at the top end of the colon.
WHAT WOULD YOU DO NEXT?
■ Lesion is benign but it can't be removed endoscopically
Best to admit defeat than to fight against overwhelming odds
■ Lesion is benign and I will organise an EMR
Not sure that anyone could remove this endoscopically
■ Lesion is benign and I will organise an ESD
■ Lesion is benign and I will organise an underwater resection
It will also fail !
■ Lesion is malignant and requires a surgical resection
Polyp is large BUT looks benign!
This is a classical LST-G (laterally spreading tumour of the granular type). These lesions are always TVA's and almost always harbour LGD. Unfortunately, there are three problems which precluded an endoscopic resection; 1) there is a crazy alpha loop in the transverse colon which as usual proved impossible to remove, 2) the movement of the diaphragm continuously moves the lesion away and towards you and 3) the main part of the lesion is in the ascending colon but then extends across to the caecum where it almost kiss the appendix orifice.
The moral of the story is to carefully consider BEFORE you start the resection. After you have started to attempt resecting a lesion such as this it becomes progressively more difficult to stop! It's like a gambler finding it increasingly difficult to walk away from the table as losses stack up. Because you have invested so much time and effort, it becomes difficult to stop and admit defeat!