结肠镜检查- IC valve EMR after two prior failed snare resections

Patient: Middle aged patient underwent two prior failed hot snare resections of an IC valve flat lesion. She was referred to surgery, but wanted to explore endoscopic mucosal resection as an option to avoid surgery if possible.
Preparation: Split dose PEG solution.
General anesthesia with endotracheal intubation.
Lesion: Flat lesion extending to one lip of the IC valve in its entirety; tethered from prior resections on the colonic side of the valve.
Injection: Inside the IC valve to evert the lesion.
Snare resection: 10 mm stiff snare resection - piecemeal resection.
Hot biopsy avulsion: Central tethered area was removed by hot biopsy avulsion - EndoCut Q3-1-3; yellow pedal - tap tap tap technique.
APC of the edge and base - 0.8 L flow and 50 Watts.
Post procedure care: Liquid diet for 2 days; low residue diet for 2 days; regular diet from day 5.

                               
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