Rectosigmoid LST-G: pEMR

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.