V13 - Double channel EMR for the challenging polyp: double the channels, twice the control for the two handed endoscopist

CME Eligible

Purpose/Background: Double channel EMR was first described in 1993 but is still seldomly used for resection of challenging polyps. Single channel EMR and ESD have become increasingly popular, but these techniques are still limited by polyps within difficult locations and ESD has a prolonged learning curve.

Methods/Interventions: We are presenting a video that showcases how the double channel approach can be used for the removal of two sessile polyps within the appendiceal orifice and ileocecal valve, locations that are technically challenging when using traditional single channel methods. We demonstrate the synergistic benefit of two working channels, allowing for greater control and exposure of the tissue during submucosal injection, snare resection and polypectomy closure. The video highlights the techniques used to ensure complete polyp excision as well as secure closure.

Results/Outcomes: Our patient recovered from his procedure without issue. He was discharged the same day and was doing well at follow up.

Conclusion/Discussion: Double channel EMR provides additional control and exposure when removing polyps within difficult locations that may have previously required colectomy. The two channels utilize the same skill sets and tools that are already familiar to endoscopists but with the added benefit of providing coordinated movements with two working endoscopic hands.