Endoscopic electroresection of gastrointestinal polyps

Endoscopic digestive polyp resection is suitable for all sizes of pedicled polyps and adenomas. Non-pediculated polyps and adenomas less than 2 cm in diameter. Multiple adenomas and polyps, scattered and small in number. Treatment of diseases: small intestine adenoma Indication Endoscopic digestive polyp resection is suitable for all sizes of pedicled polyps and adenomas. Non-pediculated polyps and adenomas less than 2 cm in diameter. Multiple adenomas and polyps, scattered and small in number. Contraindications 1. There are contraindications for endoscopy. 2. Diameter-free polyps and adenomas larger than 2 cm in diameter. 3. Multiple adenomas and polyps are confined to a densely distributed area and have a large number. 4. Familial adenoma. 5. Endoscopic morphology has been significantly malignant and suitable for surgical treatment. 6. Coagulation disorders that have not been corrected. Preoperative preparation 1. The patient is prepared for preoperative preparation by gastroscopy and colonoscopy. Check bleeding time, clotting time, platelet count, and prepare 1-2 units of blood. 2. Instrument preparation 1 Gastroscope or colonoscope with insulated design. 2 high frequency generator. 3 electrocoagulation cutting burner, including snare, thermal biopsy forceps, electrocoagulation head and so on. 4 polyp collector: such as grip pliers, baskets and so on. Check whether the snare is intact before operation, debug current intensity (soap spark method), and whether the instrument connection line is correct. The operator must be familiar with high frequency electrical performance and high frequency electrical methods. Surgical procedure The same as the upper digestive tract and colonoscopy, the specific steps are as follows: 1. First use a gauze pad (slightly larger than the electrode plate), soak it with physiological saline, place it on the electrode plate, attach it to the patient's calf or the gastrocnemius muscle, and fix it with an ankle strap. 2. Turn on the high-frequency electric power switch and select different coagulation and electric current intensity (index or W) according to the size of the polyp, especially the size of the polyp. 3. Help the hand-held electric sleeve handle, hand the end of the electric sleeve to the surgeon, and insert the endoscopic biopsy forceps into the vicinity of the polyp, so that the assistant can introduce the snare, and the surgeon covers the polyp The department is 3-4mm away from the mucosal surface, so that the assistant tightens the snare and stretches the polyp pedicle. However, it is necessary to avoid excessive force, causing the polyp machine to cut and cause bleeding. 4. The operator first steps on the electro-hydraulic foot pedal for a few seconds. To the base whitish, then step on the switch for a few seconds and slash the ferrule to cut the polyp. Both the endoscope and the high-frequency generator should be connected to the ground wire reliably during operation to ensure the safety of the patient and the operator. 5. Align the cut polyps under direct vision, press the electric suction switch and press the endoscope suction button to make the polyp absorb the end of the endoscope. When the field of view is red, the polyp has been absorbed on the mirror and continues to attract. Slowly exit the endoscope, this applies to polyps <1cm in diameter. Or take it with a grasping forceps and send the complete polyp to a pathological examination. Colon polyps can also be left in the intestine and excreted with the feces, but patients should be simmered daily to recover polyps. 6. The wound should be carefully observed after surgery. If necessary, local spray of 1:10000 adrenaline via endoscopy, or electrocautery with a coagulation electrode to stop bleeding. 7. Different types of polyps removal methods (1) The pedicle polyps should be placed 3-4mm from the mucosal surface of the pedicle (not too close to the mucosal surface to avoid burning the mucous membrane to form a deep ulcer surface), and gently lift the polyp to suspend it in the intestine. Electrocoagulation or electric cutting. During operation, the ferrule of the electric sleeve should be at least 2 cm away from the objective surface of the endoscope, and the mirror end should not be touched to avoid damage to the mirror surface. (2) The yati polyp with a diameter of less than 2 cm can be lifted to the sky-like re-coagulation. (3) Hemispherical wide basal polyps, pedunculated small polyps, can be lifted into a pedicle and then resected by thermal biopsy forceps or bilateral endoscopic surgery. (4) multiple polyps, should be divided into sub-partition resection, generally should start from the proximal end of the colon, and sequentially resected when the mirror is gradually removed. This keeps the mirror clean without contamination by blood stains and prevents the endoscope from mechanically damaging the wound.

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