A 45-year-old woman presented to the clinic with hematochezia. She described 2 years of intermittent, painless, small-volume rectal bleeding after bowel movements, without weight loss or constipation. She had no family history of colon cancer. A colonoscopy revealed a large rectal polyp (image A) with gyrus-like pits, which were well visualized with narrow-band imaging (image B). Endoscopic ultrasonography demonstrated no submucosal invasion. A polypectomy was performed piecemeal via endoscopic mucosal resection using an injectable liquid compound (SIC-8000) for submucosal lift. Histologic analysis confirmed a tubulovillous adenoma, 4.8 cm in the greatest dimension. The hematochezia resolved following polypectomy.
Colon polyps account for nearly 13% of rectal bleeding in outpatients.1 A tubulogyrus surface pattern of polyps suggests adenomatous histology.2 When found, adenomas should be resected because of the risk of malignant transformation. SIC-8000 is a Food and Drug Administration-approved agent for submucosal injection during endoscopic mucosal resection and is a safe and potentially more effective alternative to saline.3
References
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2. RastogiA, KeighleyJ, SinghV, et al.. High accuracy of narrow band imaging without magnification for the real-time characterization of polyp histology and its comparison with high-definition white light colonoscopy: a prospective study. Am J Gastroenterol. 2009;104(10):2422-2430. doi:10.1038/ajg.2009.403Search in Google Scholar PubMed
3. RepiciA, WallaceM, SharmaP, et al.. A novel submucosal injection solution for endoscopic resection of large colorectal lesions: a randomized, double-blind trial. Gastrointest Endosc.2018;88(3):527-535.e5. doi:10.1016/j.gie.2018.04.2363Search in Google Scholar PubMed
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