By Toyooki Sonoda
This e-book offers surgeons and gastroenterologists with cutting-edge strategies by way of complex colonoscopy. Chapters introduce tools of elimination polyps that weren't formerly amenable to colonoscopic snare polypectomy. complicated options comparable to closure of perforations and intestinal stenting are greatly lined. The textual content keeps a robust emphasis on surgical/endoscopic approach. large dialogue on apparatus and talent acquisition is additionally coated. As many readers won't ever have obvious those complicated techniques sooner than, vast pictures and movies are supplied. The authors supply information, tips, and pitfalls that would aid the reader contain those new recommendations into their practice.
Advanced Colonoscopy: Polypectomy and past could be of significant price to any health care professional or gastroenterologist presently appearing colonoscopy and attracted to complicated techniques.
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Extra resources for Advanced Colonoscopy: Principles and Techniques Beyond Simple Polypectomy
EUS is used for special cases of scarred lesions or those with suspicion of massive submucosal invasion by magnifying endoscopy. Recently, equipment-based image-enhanced endoscopy (IEE) such as narrow-band imaging (NBI), flexible spectral imaging color enhancement (FICE), and i-scan has replaced 42 K. Niimi et al. chromoendoscopy to some extent. Biopsy is not necessary because the prediction of malignancy is completely accomplished by chromoendoscopy, and biopsy may cause unnecessary submucosal fibrosis which makes the following ER more difficult and more risky.
Kato References 1. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43. 2. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004;127(2): 385–94. 3. Saitoh Y, Obara T, Watari J, Nomura M, Taruishi M, Orii Y, et al.
The basic technique for using insulated tip types of devices involves the ability to pull or slide the device laterally from side to side. The IT knife has a ceramic ball at the tip of a needle knife, which insulates the tip, so that cutting is achieved not by the tip but by the blade of the needle. The best way to use it is to place the ceramic ball in the submucosal layer to hook the mucosa or the submucosal connective tissue and then pull back on the knife. This is the only way to cut smoothly using an IT knife, so the knife sometimes has to be applied blindly, which risks complications such as bleeding and perforation.