RU-2861509-C1 - METHOD FOR COLD SNARE RESECTION OF FLAT EPITHELIAL LESIONS OF COLON

Abstract

FIELD: medicine. SUBSTANCE: invention relates to intraluminal operative endoscopy. When performing cold snare resection of flat epithelial lesions of the colon, to capture the lesion with a snare, a preliminary pulling of the lesion towards the endoscope is performed using an endoscopic loop enabling capture by aspiration. The subsequent stages of removal are performed with the same loop. EFFECT: possibility of performing capture and cold snare resection of flat epithelial lesions of the colon. 1 cl, 4 dwg, 1 ex

Inventors

• Bashirov Ramil Azer ogly

Dates

Publication Date

20260505

Application Date

20250822

Claims (1)

1. A method of cold loop resection of flat epithelial formations of the colon, characterized in that in order to capture the formation with a loop, the formation is first pulled toward the endoscope with an endoscopic loop, which ensures the possibility of holding it by aspiration, after which the subsequent stages of removal are performed with the same loop.

Description

The invention relates to the field of medicine, namely to intraluminal operative endoscopy, and is used for the resection of flat epithelial formations (formations of type 0 - IIa and 0 - IIb according to the Paris endoscopic classification of superficial neoplastic lesions). It has been proven that removal of adenomatous colon polyps during colonoscopy can reduce mortality from colorectal cancer. In recent years, simpler and safer endoscopic polypectomy methods have become routinely used, allowing endoscopists to remove detected tumors, including in outpatient settings. Of these methods, cold loop resection of epithelial colon tumors has become the most widely used worldwide due to its advantages, including reduced procedure time, reduced risk of immediate and delayed bleeding, and reduced risk of perforation. With this method, the polyp is mechanically removed with a polypectomy loop without applying electrical current. An unresolved problem in performing cold loop polypectomy is the inability in some cases to capture flat epithelial formations with the endoscopic loop. Factors that make it impossible to capture a polyp with an endoscopic loop include flat forms of neoplasms (formations of type 0-IIa and 0-IIb rise less than 2.5 mm above the mucosa), small sizes of neoplasms, localization of formations behind high haustric folds, and previous operations that led to adhesions in the abdominal cavity. The objective of the invention is to increase the efficiency of cold loop resection of flat epithelial formations of the colon. The technical result consists in ensuring the possibility of capturing flat epithelial neoplasms when performing cold loop polypectomy. This is achieved by the fact that if it is impossible to capture the polyp with a loop, the formation is first pulled up by aspiration with an endoscopic loop - an aspirator, after which the subsequent stages of removal are performed with the same loop. For this purpose, an endoscopic aspirator loop (Fig. 1) is used, made of a metal wire enclosed in a flexible catheter - a tube made of polymer material and connected to a handle, which, unlike a conventional endoscopic loop, has a port at the proximal end of the tube closer to the handle of the loop for connecting an aspirator, which provides the ability to pull up by aspiration of the epithelial formation when performing endoscopic polypectomy. Images explaining the essence of the invention: Fig. 1 - endoscopic aspirator loop: 1 - port for connecting an additional aspirator; Fig. 2, Fig. 3 - mucosal protrusions (suckers) formed by the aspirator loop, including the identified flat epithelial formations; Fig. 4 - retention by aspiration of the removed epithelial formation. Cold loop resection of epithelial lesions of the colon consists of the following stages: 1. The neoplasm with a rim (reserve) of visible normal tissue is captured with a loop using air aspiration (carried out through the instrument channel of the endoscope). 2. The loop is closed and the polyp is mechanically cut off. 3. The removed polyp is removed for histological examination. If it is impossible to capture the polyp with a loop, the proposed method for removing flat epithelial formations of the colon using an endoscopic aspirator loop is used: 1. The endoscopic aspirator loop is passed through the instrument channel of the endoscope and brought out into the intestinal lumen. 2. Using the distal end of the endoscope, under visual control, the aspiration loop is moved towards the formation to be removed. 3. The aspirator loop is applied to the surface of the polyp. 4. During aspiration, carried out through the catheter of the endoscopic aspirator loop itself and leading to the suction of the removed polyp to the distal tip of the loop, the polyp is pulled as much as possible towards the endoscope until it is torn away from the loop in order to form a protrusion (suction cup) protruding above the surrounding mucosa (Fig. 2, Fig. 3). 5. If necessary, the formation is pulled up again by aspiration, including from different edges of the formation in the case of large polyps. 6. Under visual control, the resulting protrusion with the polyp and a rim of normal tissue is captured with an aspirator loop. 7. The loop is closed and the polyp is mechanically cut off. 8. If the loop is not completely cut and gets stuck in the polyp tissue, the loop with the trapped polyp is pulled towards the endoscope as much as possible. If the mucosa with the pulled-up polyp is under tension, the endoscope is further retracted from the removal site and the loop is pulled towards the endoscope again as much as possible (inserted into the instrument channel); under visual control, the loop is slightly opened to release the mucosal defect cord formed by the cold loop (CDL), which appears as a narrow white band extending from the base of the defect to the polyp and consisting of the muscularis mucosa and submucosal tissue. It is important to only slightly open th