Colonoscopy and polypectomy with a side-viewing endoscope.
OBJECTIVE
Some colorectal polyps cannot be adequately viewed using forward-viewing colonoscopes because of their location behind mucosal folds or bends in the bowel. We performed polypectomy using side-viewing duodenoscopes for these problematic polyps in order to avoid incomplete polypectomy or the need for surgical intervention.


METHODS
Between April 2000 and August 2003, polypectomy with a side-viewing endoscope was intended in 15 patients (seven men, eight women; mean age 63.7 years, median age 59 years, range 38-88 years) at our institution. In all these patients, polypectomy had been attempted previously with a forward-viewing colonoscope by at least one experienced endoscopist without success. The duodenoscope was advanced with slight bending of the tip to achieve a sloped forward view.


RESULTS
Colorectal polyps were macroscopically completely removed in 11/15 patients. One polyp near the ileocecal valve could only be partially removed with the side-viewing endoscope; and one large flat rectal adenoma, one recurrent rectal polyp (after a previous incomplete conventional polypectomy), and one polyp near the ileocecal valve could not be removed. We observed no procedure-related complications. Endoscopic follow-up was possible in seven of the 11 patients in whom the polyps were successfully resected, with no evidence of recurrence (mean follow-up 27 months).


CONCLUSIONS
Polypectomy with the side-viewing duodenoscope is a safe and effective method. It is a therapeutic option when polyps are not adequately accessible using a conventional approach.
Frimberger
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Department of Internal Medicine II, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany. Eckart.Frimberger@lrz.tu-muenchen.de
von Delius
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Rösch
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Schmid
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D000328:Adult; D000369:Aged, 80 and over; D000818:Animals; D003111:Colonic Polyps / Q000175:diagnosis* / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D020698:Duodenoscopes; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence