Advanced Colon Polypectomy Klaus Mönkemüller, Helmut Neumann, Peter Malfertheiner, Lucia C. Fry  Clinical Gastroenterology and Hepatology  Volume 7, Issue 6, Pages 641-652 (June 2009) DOI: 10.1016/j.cgh.2009.02.032 Copyright © 2009 AGA Institute Terms and Conditions

Figure 1 This polyp is located in the 12 o'clock position (A). The ideal position for colon polypectomy is when the polyp is located at the 5 o'clock position, because this is where the accessory material exits the working channel of the colonoscope (B). If the polyp is located in another position, torquing and stretching movements should be performed to “face” the polyp in the ideal position. Panel C shows the resected polyp, and panel D shows the polypectomy site. Clinical Gastroenterology and Hepatology 2009 7, 641-652DOI: (10.1016/j.cgh.2009.02.032) Copyright © 2009 AGA Institute Terms and Conditions

Figure 2 Adequate formation of the submucosal cushion after injection of epinephrine-saline mixture 1:10,000 (A). The polyp was resected in toto, leaving a nice mucosectomy site (B). Clinical Gastroenterology and Hepatology 2009 7, 641-652DOI: (10.1016/j.cgh.2009.02.032) Copyright © 2009 AGA Institute Terms and Conditions

Figure 3 Adequate mucosectomies of sessile polyps in the ascending colon. Whereas polyp in (A) was resected by using the piecemeal technique (C), the polyp in (B) could be resected in one piece because the submucosal cushion rose to form a broad “pseudostalk” that could be snared in one piece. Both mucosectomy sites do not show any evidence of residual neoplastic tissue (C, D). If there is a question of remaining tissue, APC can be applied to the borders. Occasionally, obtaining biopsies of the margins can also be used as objective evidence to evaluate for neoplastic tissue. Clinical Gastroenterology and Hepatology 2009 7, 641-652DOI: (10.1016/j.cgh.2009.02.032) Copyright © 2009 AGA Institute Terms and Conditions