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Our short teaching videos are mini-learning opportunities for busy clinicians with a few minutes to spare!  The idea is to give you a quick reminder of issues, rather than a 30 minute in-depth review !  


Rectosigmoid LST-G: pEMR

7/2/2021

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A 60 year old woman with type 2 diabetes and hypertension was found to be FIT+ve under the UK Bowel Cancer Screening Programme. The index colonoscopy, performed by a colleague 2 weeks ago, showed 4 polyps in the sigmoid / rectosigmoid colon. The three smaller polyps (6-15mm diameter) were removed (tubular adenoma, low grade dysplasia). The largest polyp, a 5cm LST-G  on a fold at the rectosigmoid junction was left behind for another day. The LST-G was not biopsied. The patient now attends for a further procedure to remove the LST-G (see video…).


The video highlights several tips:
  1. Using a gastroscope to improve access in a tricky area of the bowel.
  2. Using retroflexion to get better views of a polyp draped over a fold.
  3. Using good volumes of lift solution to get a decent cushion.
  4. Using gravity to your advantage by rotating the patient.
  5. Extending the defect contiguously and systematically.
  6. Using Coagrasper to control bleeding.
  7. Using snare-tip Softcoag to treat the edges of the defect.
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Rembacken's Resection Rules

7/2/2021

 
'Rembacken's Resection Rules' is a 'tongue in cheek' list of General Principles which helps me in my endoscopic practise.   They have stood the test of time !!! 

Contralateral burn in a spastic sigmoid

4/2/2021

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Sigmoid snare polypectomy in spastic, tight sigmoid. Teaching points include:
  • Use a Gastroscope
  • Removal in retrovertion can be impossible
  • Consider buscopan for spasm
  • Allow 40-60 minutes
  • Full colon bowel cleansing
  • Keep snare away from mucosa
  • Recognise collateral burns and apply clips

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Snare polypectomy

3/2/2021

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Small polyp on thick stalk for snare polypectomy at the recto-sigmoid junction cocked up! 
Teaching points include:
  • Don't rush it! 
  • Bring polyp down to 6 O'clock or resect in retrovertion
  • Assess snare position before cutting 
  • Immediate bleeding is easy to deal with
  • Assess for complete excision
  • Consider clips 
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EMR of 20mm sigmoid polyp

2/2/2021

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EMR of a 20mm sigmoid polyp.  Main teaching points includes:
  • Use a gastroscope
  • Removal in retrovertion is easier
  • Give full colonic prep
  • Keep the resection area clean and dry
  • Anticipate bleeding before it happens
  • Deal with bleeding straight away
  • Place the first clip on the most awkward spot
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Lugol's iodine to map squamous dysplasia

2/2/2021

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A short clip of Lugol's dye spray. Teaching points includes:
  • Squamous dysplasia is well seen by blue light technologies
  • First wash with lots of acetylcysteine
  • Consider topical lignocaine but don't mix it with Lugol's
  • Dilute the 5% Lugol's down to 1%
  • Flat squamous dysplasia can usually be resected whilst nodules usually can't be
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    Rembacken's Rules
    Snare Polypectomy
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