Freehand Resection of a Stoma Polyp Using Endoscopic-Based Techniques

Introduction: Colon polyps originating at stoma sites are a rare entity. In this report, we describe a unique case of an adenomatous stoma polyp that was resected without sedation using simplified endoscopic-based techniques. Case Description/Methods: A 64-year-old woman with recently diagnosed stage IIIB rectal cancer underwent an emergent diverting colostomy at an outside hospital for a lower bowel obstruction. On follow-up, the patient was found to have a polyp originating from the colonic mucosa at the ostomy opening. The patient was referred to our service for endoscopic resection of the polyp. The patient was placed in the supine position, and the stoma bag was removed. The polyp was pulled and exposed, and appeared pedunculated, approximately 3cm long, with a 1 cm thick stalk. The colonoscope was inserted through the stoma and confirmed normal residual colon exam to the level of the cecum. Two 22 mm clips were placed at the base of the stalk using a freehand technique while applying gentle retraction of the polyp. Subsequently, a 20 mm stiff hot snare was positioned above the clips at the base of the stalk. The patient was grounded, and the polyp was resected using electrosurgical settings: endocut Q current, effect 3, interval 1, soft coag effect 2: 50 Watts. Afterward, the post-polypectomy site was inspected carefully. There was no bleeding or perforation, and the procedure was well tolerated. The pathological examination showed a tubulovillous adenoma with multifocal high-grade dysplasia. The resection margin was free of adenoma. The patient was treated with total neoadjuvant therapy and is being evaluated for laparoscopic low anterior resection and takedown of loop-diverting colostomy (Figure 1). Discussion: Stoma polyps are very rare and, therefore, seldom reported in the literature. This case describes a simplified technique for removing polyps at the stoma site by gastroenterologists using endoscopy-based techniques without the need for sedation. Watch the video at https://tinyurl.com/S2638ACG2023.Figure 1.: The polyp was pulled and exposed (A, B) outside the stoma, and resection was performed (C) as shown in the video. No bleeding or complications post polypectomy (D).