Polypectomy with ENDO CUT Q
The ERBE VIO® GI Workstation - versatility and safety in flexible endoscopy
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Controllable cutting during polypectomy (here a stalked polyp in the colon) and mucosectomy procedures with the VIO ENDO CUT Q Mode. The first cut during the initial cutting phase spares the tissue at the base of the polyps (see detailed fig. 2). Homogeneous cutting and safe hemostasis further reduce the risk of perforation. Minimal coagulation minimizes the risk of postoperative peritonitis. The ENDO CUT Q mode (see detailed fig. 1), an optional upgrade, is available for the electrosurgical VIO units, some of which can be retroactively equipped with the mode. |
Indications
- Polyps < 2 cm (flat, raised lesions, sessile, waisted or stalked polyps)
- EMR: mucosal, neoplastic-suspicious lesions or polyps > 2 cm
Advantages of ERBE equipment
- Precise and fast initial cut with PPS
- Customized solution for the requirements of polypectomy and mucosectomy
- Reliable cutting impulse recognition
- Adjustable and reproducible hemostasis based on four effect settings
- The fractionated cutting mode ENDO CUT Q is characterized by alternating cutting and coagulation cycles
- Cut duration and cutting interval can be adjusted via the VIO display
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Operation steps
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Elevating the lesion
An important precondition for a successful and safe polypectomy or mucosal resection is elevation of the lesion (the polyp or mucosa) so that it stands out clearly from the muscularis propria (lifting sign) using the electrosurgical snare.
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Placing the electrosurgical snare
The snare should be placed around the lesion parallel to the intestinal wall, pressing lightly against the wall; the snare should then be closed slowly and lifted up parallel to the intestinal wall (fig. left). It is important to avoid one-sided tissue contact of the snare tip to the intestinal wall (fig. right).
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Placing the electrosurgical snare II
Visual control of the grasped tissue is important: if too much tissue has been grasped (including part of the wall) the snare should be opened and less tissue should be grasped (a). It is important to avoid to much traction on the electrosurgical snare as this will lead to mechanical excision of the lesion without coagulation and therefore increase the risk of bleeding.
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Ablation of stalked polyps
Stalked polyp in the colon after being grasped by the snare (fig. left). Slight coagulation at the base of the polyp after polypectomy (fig. right - white area at 11 o’clock). Stalked (pedunculated) polyps between 5–15 mm in size (polyp head) can be ablated using either the FORCED COAG mode or ENDO CUT Q. The polypectomy snare should be positioned close beneath the head of the polyp at a distance from the intestinal wall. Large stalked polyps (> 15 mm) are generally associated with a higher risk of bleeding. During the resection of large stalked polyps with ENDO CUT Q we recommend carrying out bleeding prophylaxis either by submucosal injection, electrosurgical preconditioning, or by clipping.
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