the polyp was injected with a mixture of normal saline and indigo carmine using a Carr-Locke injection needle, providing
Lariat® snare Lariat® snare Case Report Series • Report 1 snare
“The Lariat® [snare] was the best option for a complete en bloc resection of this complex rectal polyp to ensure the margins were clean and no further resections would be required.” A. Aziz Aadam, MD Interventional Gastroenterologist Rush University Medical Center Chicago, IL
Procedure
Indications
Colonoscopy with resection of 4cm pedunculated
A 92 year old female presented with rectal bleeding and was found to have a large rectal polyp during a previous colonoscopy. Biopsies revealed a “tubulovillous adenoma with foci of at least high grade dysplasia.” The patient was evaluated by the interventional endoscopy and colorectal surgery teams at Rush University Medical Center.
rectal polyp (Paris classification type 1sp sub-pedunculated).
Endoscopic mucosal resection
A 4cm polyp was identified, and the decision was made to attempt endoscopic mucosal resection. The area surrounding the polyp was injected with a mixture of normal saline and indigo carmine using a Carr-Locke injection needle, providing an excellent lift of the lesion. The Lariat® snare was chosen because of the large oval snare size (30mm) along with its stiff wire and “V-notches” needed to work over the 40mm polyp and ensure precise positioning around the wide, pedunculated base. Once the polyp was resected, moderate bleeding occurred, and hemostasis was achieved following epinephrine injection and hemoclip placement. Pathology results revealed a “tubulovillous adenoma with extensive high grade dysplasia with a small focus of invasion into the lamina propria indicating intramucosal adenocarcinoma.” The lesion was completely excised. No further therapy or interventions were required since the patient’s superficial cancer was completely resected. Patient will have a follow up screening colonoscopy in 6 months.
1. 4cm pedunculated rectal polyp
2. Lariat® snare in retroflexed position
3. En bloc resection with Lariat® snare
4. Clipped resection site
To watch the full clinical video, visit www.usendoscopy.com/lariat
