Practical Gastrointestinal Endoscopy

THERAPEUTIC COLONOSCOPY 197
(b)
(c)
(d)
Fig. 7.43 (a) Endoscopic mucosal resection (EMR) lipped cap on scope tip, with snare loop opened. (b) Polyp
elevated by injection. (c) Injected tissue suctioned in. (d) Electrosurgical snaring and transection.
3–Inject saline beneath the polyp or area of mucosa to be resected,
to elevate it away from the muscular layer below and make
excision safer and easier.
4 –Suction the mucosa against the cap to help open the special
EMR snare loop against the internal lip of the suction cap (unless
this has been pre-loaded) (Fig. 7.43b).
5–Suction until the mucosa completely fills the transparent cap,
becoming encircled by the EMR snare loop (Fig. 7.43c).
6–Snare off the specimen and suction it into the cap for withdrawal
with the endoscope (Fig. 7.43d).
7–Reinsert the scope through the overtube for multiple resections—which
can remove extensive areas of mucosa, if indicated.
OTHER THERAPEUTIC PROCEDURES
Balloon dilation
Balloon dilation of short strictures and anastomoses is easy
with ‘through-the-scope’ (TTS) balloons, especially those with
an internal guide wire. TTS balloons now furl tightly enough to