Patient: Middle aged woman was referred for EMR of a large flat lesion.
Preparation: Split dose preparation.
Anesthesia: Started with total intravenous anesthesia; after noticing respiratory movements, requested anesthesia to place endotracheal tube to allow controlled breathing.
Colonoscopy: Cap fitted colonoscope.
Lesion: Ascending colon flat lesion that required rotation of the patient to allow the lesion to come to a better position for resection.
Injection: Indigo Carmine saline solution; 3 injections; 12 ml.
Snare resection: 15 mm snare - stiff snare; enbloc resection.
Resection base: Blue (submucosa); edge clean; vessel bleeding noted.
Water jet was used to control the bleeding while APC probe was inserted to avoid flooding of the field with blood as the lesion was in a dependent position.
APC of the edge
Clip closure: 4 clips.
Specimen: Fixed on cardboard.
Post-procedure Diet: Liquid diet for 2 day; low residue diet for 2 days; regular diet on day 5.
Mild post-procedure discomfort for first 48 hours; normal abdominal exam.
