Video Tip: Reasons for Adherent Polyp/Failure to Lift | August 2021-Reasons for Adherent Polyp Failure to Lift

Video Transcription

What are reasons for that the polyp doesn't come off? Why do you still have some residual there? So one of them is partial snare polypectomy.  The snare sort of goes on as it's grabbing tissue. Maybe it folds up. Maybe it's across a fold and you get some residual there that then tends down.  In a lot of cases, tattoo will cause a local inflammatory response and cause some scarring. Usually this happens when somebody tries to do their best to help facilitate removal in  the future and decides that they're going to inject tattoo, let's say, two folds before or after where this polyp is and then send them to you so that you can try to resect it.  Well, actually, a lot of times that tattoo, even though you're two folds away, might actually be closer than you think. And it has been known to track several folds in advance.  So there have been cases where that tattoo, even though it might've been injected 10 centimeters  away from a lesion, has sort of gone through that area and caused a local scar area so that that polyp will no longer lift.  The other thing is, and avoid this, if you don't have plans to take out a polyp, don't biopsy it.  Because biopsying, again, will create a local inflammatory reaction in there and cause scarring to go down so that now you have an area that's sort of tented.  It won't raise and lift because of the biopsy effects. So if you see a lesion, you don't feel comfortable taking it off at that point, or it's not the  right time, the patient hasn't gone through sort of the full risk and benefits because you think you're going to do an EMR, which has a little bit higher risk of adverse event  involved, always bring them back. Do not sample it. I would not inject solution around anywhere in that vicinity or that area.  You'll be able to come back, photo document, count your folds, and come back for another time to avoid failure to lift.  And then the location of the rectum also tends to have more areas where that polyp won't sort of go up well with a polypectomy lift.  For more information visit www.FEMA.gov

Video Summary

The video discusses reasons why a polyp may not come off during a procedure. One reason is a partial snare polypectomy, where the snare folds up or is across a fold, leaving some residual tissue. Another reason is the use of tattoo ink during a previous attempt to facilitate removal. Even if the tattoo is injected a couple of folds away from the polyp, it can cause scarring and prevent the polyp from lifting. Biopsying a polyp can also create scarring and tenting, making it difficult to remove later. It is advised to not biopsy a polyp if there are no plans to remove it. Instead, bring the patient back for further evaluation. The location of the polyp in the rectum can also affect its ability to lift. More information can be found at www.FEMA.gov.

Keywords

partial snare polypectomy

tattoo ink

scarring

biopsy

polyp location