Endoscopic resection of polyp invading diverticula – Tips/tricks/key points

                                                                                                                                                                          Posted by Dr Pradeep Mundre

​Highlighting some key points, Tips/Tricks when considering endoscopic resection of polyps invading diverticula


1. More often the polyp just invades partially superficially into the diverticula, making it easy to tease it out during endoscopic resection
2. For most such polyps conventional EMR should be enough- Ensure that the lifting is in the right plane starting lift away from diverticula gradually moving towards.
3. There is a risk of perforation as no muscularis propria in diverticula
4. Clear cap always helps for any complex resection
5. There is often poor lifting of polyp around the diverticula
6. When resecting the polyp tissue within the diverticula, deflating the lumen and releasing the luminal tension helps
7. Stiff snare (I used medworks flat band snare here) may help get better hold of polyp
8. Underwater resection helps similarly
9. Despite macroscopically complete resection, risk of Recurrent/Residual polyp is high, so always consider site check @ 4-6 month and once again at 18 months
10. Other methods include EFTR, Band ligate and leave (post biopsy) approach or surgery
 

                                                                                                                                                                                           Dr Pradeep Mundre