case_images: PMC9891143_01
case_images: a, b Endoscopic illustration of a large pedunculated Paris Ip lesion estimated at 50 mm in the sigmoid colon with an uneven, multinodular surface. Limited optical assessment suggested adenoma-typical regular surface and vessel pattern. c Of note, the estimated 25-mm stalk exhibited prominent stalk varices. d, e Visualization of the first anal side endoscopic band ligation (d) and the second one at upper left (e) (note marked traction-related stalk shortening). f Cap-fitted visualization of the operative situs with the two ligations at 6 o'clock and the polyp head at 12 o'clock.
case_images: pjg-0030-0076-g01.jpg
case_images: PMC9891143_01_pjg-0030-0076-g01.jpg
case_images: F1
case_images: While smaller polypoid lesions in the remaining colon were resected without complications, an estimated 50-mm, complex pedunculated (Paris Ip) lesion with a unique multinodular, uneven surface was observed in the sigmoid (Fig. 1a). However, dedicated optical assessment of large areas of the lesion indicated adenoma-typical vessel and surface pattern, albeit full optical assessment of the large and floppy lesion was not feasible (EC760R-V/I; Fuji, Dusseldorf, Germany) (Fig. 1b). More intriguingly, the 25-mm-long and 10-mm-wide stalk demonstrated marked varices originating from adjacent flat sigmoid mucosa (Fig. 1c). To this end, we provided the insertion point at 35 cm with two rubber bands as per standard procedure (Fig. 1d, e). Cap-fitted gastroscope reinsertion exposed the edematous stalk with the ligations at 6 o'clock and the polyp head at 12 o'clock (Fig. 1f).
case_images: a Stalk transection using a scissor-type knife (3.5-mm ClutchCutter, Fuji) utilizing an 18.1-mm large-diameter oblique transparent cap (D-206-5; Olympus, Hamburg, Germany) for improved intracap device rotation. b Progression of transection prior to the final cut; note lack of hemorrhage during the procedure. c Final endoscopic result with the two ligations still in situ and lack of bleeding. d Ex vivo representation of the specimen after Roth net retrieval.
case_images: pjg-0030-0076-g02.jpg
case_images: PMC9891143_01_pjg-0030-0076-g02.jpg
case_images: F2
case_images: Next, we completed an uncomplicated forceps scissor transection of the highly fibrotic stalk, using a scissor-type knife device, only at the first cut resulting in self-limited bleeding from ligated varices (Fig. 2a, b). Tubingen, Germany) Postinterventional assessment of the resection site excluded hemorrhage with the two bands still in situ (Fig. 2c). The specimen was retrieved by a Roth net. Final pathology confirmed R0 resection of low-grade intraepithelial neoplasia (Fig. 2d).