Where to inject?
This is beautiful polyp, perched on a fold, was found at the junction between the caecum and the ascending colon. The video gives you a better idea of the size and extent of the lesion.
WHERE WOULD YOU PLACE THE NEEDLE FOR THE BEST 'LIFT' ?
■ On the side facing you
A convenient choice but lift will not be optimal
■ Into the apex of the polyp
That would be my choice!
■ Just behind the lesion
Better than into the fold facing you
I have no qualms about injecting straight into the middle of lesion provided that I'm sure that it's benign. The lovely gyrate pattern of this polyp tells you that it's a TVA, likely to harbour no more than LGD. Injecting into the fold facing you is likely not to raise the 'blind side' of the polyp which extends down the back of the fold and onto the 'flat' beyond. Conversely, injecting into the back of the lesion would lift the back end but probably not the front. My choice was to inject into the apex (see video below) which resulted in a lovely lift. But, why not inject in two places? Because you should try to avoid injecting into more than one place (if it can be avoided). If you have made more than one hole in the epithelium you may will find that your injection leaks out through the previous hole and that the elevation is less effective. Of course when removing large, flat lesions multiple injection sites can't be avoide, unless you are removing the lesion by ESD of course.