Underwater Cold Forceps Polypectomy for an Adenoma within a Cecal Diverticulum

Article information

Clin Endosc. 2021; Epub ahead of print.
Publication date (electronic) : 2021 May 26
doi : https://doi.org/10.5946/ce.2021.038
1Department of Gastroenterology, Saiseikai Yamaguchi Hospital, Yamaguchi, Japan
2Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
3Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
Correspondence: Sho Sasaki Department of Gastroenterology, Saiseikai Yamaguchi Hospital, Midorimachi 2-11, Yamaguchi 753-8517, Japan Tel: +81-083-901-6111, Fax: +81-083-901-6111, E-Mail: sho.ssk.nv21@gmail.com
Received 2020 December 30; Revised 2021 January 13; Accepted 2021 January 14.

Endoscopic resection of a polyp involving a colonic diverticulum is challenging. As there is no muscularis propria within a diverticulum, the potential risk of perforation associated with endoscopic resection must be considered [1,2].

A 72-year-old man underwent follow-up colonoscopy after surgery for rectal cancer. A sessile polyp, 3 mm in size, was found in a cecal diverticulum. The underwater method eliminated halation and expanded the diverticulum cavity, making it possible to observe the lesion stably (Fig. 1A, Supplementary Video 1). Subsequently, underwater cold forceps polypectomy (CFP) was performed using Radial Jaw4-Jumbo cold polypectomy forceps (Boston Scientific, Tokyo, Japan) (Fig. 1B, C). Observation using narrow-band imaging and continuous irrigation confirmed that there were no residual lesions or perforations (Fig. 1D), and the wound was closed using clips. The pathological result was a tubular adenoma (Fig. 2).

Fig. 1.

Underwater cold forceps polypectomy. (A) A sessile polyp 3 mm in size was found in a cecal diverticulum. The underwater method improved polyp visualization. Narrow-band imaging (NBI). (B, C) Underwater cold forceps polypectomy was performed. (D) Observation using NBI and continuous irrigation confirmed that there were no residual lesions or perforation.

Fig. 2.

Resected specimen. Histopathological examination revealed a tubular adenoma.

The underwater method made it possible to expand the diverticulum cavity and float the lesion, allowing CFP to be performed safely [3]. Cold biopsy forceps polypectomy was performed to avoid the risk of delayed perforation associated with hot polypectomy [4]. This technique may be useful for cold snare polypectomy of larger polyps extending into a diverticulum [5]. However, it would not be safe for large polyps involving more than one-fourth of a diverticulum. To the best of our knowledge, this is the first reported case of underwater CFP for an adenoma within a colonic diverticulum.

Notes

Conflicts of Interest: The authors have no potential conflicts of interest.

Funding

None.

Author Contributions

Supervision: Isao Sakaida

Writing-original draft: Sho Sasaki

Writing-review&editing: Jun Nishikawa

Acknowledgements

We express our gratitude to Dr. Shuji Wasaki (Wasaki Clinic, Tsuwano, Japan) for his careful endoscopy and detection of the lesion.

Supplementary Material

Video 1. Underwater cold forceps polypectomy for an adenoma within a cecal diverticulum (https://doi.org/10.5946/ce.2021.038.v001).

ce-2021-038-v001.mp4

References

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3. Binmoeller KF, Weilert F, Shah J, Bhat Y, Kane S. “Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 2012;75:1086–1091.
4. Kubosawa Y, Nishizawa T, Kinoshita S, Nakazato Y, Uraoka T. Cold snare polypectomy for polyp adjacent to colonic diverticulum. VideoGIE 2018;3:85–86.
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Article information Continued

Fig. 1.

Underwater cold forceps polypectomy. (A) A sessile polyp 3 mm in size was found in a cecal diverticulum. The underwater method improved polyp visualization. Narrow-band imaging (NBI). (B, C) Underwater cold forceps polypectomy was performed. (D) Observation using NBI and continuous irrigation confirmed that there were no residual lesions or perforation.

Fig. 2.

Resected specimen. Histopathological examination revealed a tubular adenoma.