ASGE DDW Videos from Around the World | 2024-LARGE PEDUNCULATED DUODENAL POLYP RESECTION USING THE DOUBLE SCOPE TECHNIQUE

Video Transcription

Endoscopic resection of large pedunculated polyps in the etudinum is challenging, with most of these large polyps available for surgical resection.  The double-scope technique enables precise exploration of the lower surface of large polyps.  This approach allows us to maintain an intraluminal good field of vision through the resection process, reducing the risks of bleeding and minimizing the area of the mucosal defect.  A series of polypectomy cases were successfully done in our unit using the double-scope technique,  including two previous cases of GOJ guests and a fibroepithelial tumor at D1-D2 junction. Our case today is a 63 male patient who presented with melina, with no other comorbidities.  Initial OGD revealed large bleeding duodenal polyp, which thought to be a guest at that time.  EUS was arranged, which revealed a wide-based lesion 2.8 by 1.3 millimeter D1 lesion, which  thought to be a fibrolipoma at that time, that was not attached to the muscularis propria. The patient was planned for polypectomy under GA, using a double-scope technique for the  following reasons. The wide base of the polyp, which required elongation for better visualization of the base, the polyp was highly mobile and kept flipping into the pylorus.  Proper exploration of the polyp and its base, which showing that how highly mobile it is and already flipping into the pylorus from D1.  The first end loop was introduced through the main scope and adjusted by the second scope after traction and elongation of the polyp by the main scope.  Then the second end loop was inserted using the same technique as the first one.  After that using a 25 mm snare was applied above the end loop and position was checked and adjusted with the second scope.  After that using only the main scope the remaining parts of the polyp was removed.  Revealing a clean base at the polypectomy site.  Then the defect was closed using over the scope clips and graspers.  The resected polyp was almost 4 cm in size. Conclusion, advantages of using the double-scope technique in large polyps resection are maintain  an intra-luminal good field of vision through the resection process, reducing the risks of bleeding and minimizing the area of the mycosal defect, and with the use of the second  scope the snare and the end loops can be placed in an optimum position under direct visualization.

Video Summary

The video discusses the challenging yet successful endoscopic resection of large pedunculated polyps in the duodenum using the double-scope technique. This method allows for precise exploration and visualization of the polyps' lower surface, minimizing bleeding risks and reducing mucosal defects during resection. The case study presented a 63-year-old male with a bleeding duodenal polyp, successfully removed using the double-scope technique. By elongating and stabilizing the polyp with two scopes, a 25 mm snare was applied for resection. Over the scope clips closed the wound post-resection. The advantages of this technique include maintaining clear vision and minimizing bleeding risks while ensuring optimal snare placement under direct visualization.

Asset Subtitle

Mohamed Osman

Keywords

endoscopic resection

pedunculated polyps

duodenum

double-scope technique

over the scope clips