Successful Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Colonic Polyps in a 62 Y.O. Male

Chief Complaints

A 62-year-old male patient with a body mass index (BMI) of 21 presented to the Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of intermittent constipation characterized by passage of hard stools and associated flatulence for the past four years.

On examination, the patient was conscious, coherent and oriented. Vital parameters were stable within normal limits. Systemic examination revealed a soft and non-tender abdomen. Cardiovascular and respiratory system examinations were normal with no abnormal findings noted.

Upon admission to PACE Hospitals, following the clinical assessment, the Gastroenterology team conducted a comprehensive evaluation of the patient’s long-standing history of constipation, characterised by passage of hard stools, along with persistent flatulence, and a detailed review of his medical and surgical history. Baseline investigations, including complete blood picture, liver function tests, renal function tests, serum electrolytes, coagulation profile, viral screening, and chest X-ray, were performed and were within normal limits.

Clinical examination and colonoscopic evaluation revealed the presence of colonic polyps, including a pedunculated polyp in the ascending colon and a diminutive polyp at the hepatic flexure, along with associated external hemorrhoids. These findings were consistent with the patient’s gastrointestinal symptoms.

Based on the confirmed diagnosis, the patient was advised to undergo Colonic Polyps Treatment in Hyderabad, India, under the expert care of the Gastroenterology Department.

After a detailed consultation with consultant gastroenterologists, Dr. Govind Verma, Dr. M. Sudhir, and Dr. Padma Priya, along with endocrinologist Dr. Tripti Sharma and cardiologist Dr. Seshi Vardhan Janjirala, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of long-standing constipation with hard stools since 4 years, persistent flatulence since 4 years, psoriatic arthritis since 15 years, diabetes mellitus since 7 years, benign prostatic hyperplasia since several years, and prior EMR since 2 years, an optimal treatment strategy was formulated.

Based on clinical assessment and colonoscopic findings confirming a pedunculated polyp in the ascending colon, a diminutive polyp at the hepatic flexure, and associated external hemorrhoids, along with laboratory investigations being within normal limits, it was determined that Endoscopic Mucosal Resection (EMR) combined with Endoscopic Submucosal Dissection (ESD) was identified as the most suitable therapeutic intervention to remove colonic polyps, reduce the risk of malignant transformation, relieve gastrointestinal symptoms, and minimize procedural discomfort and recovery time compared to conventional surgery.

The patient and his family members were counselled regarding the diagnosis, the planned procedure, associated risks, and its potential to relieve symptoms, improve gastrointestinal health, and enhance quality of life.

Following the decision, the patient was scheduled for Endoscopic Mucosal Resection (EMR) combined with Endoscopic Submucosal Dissection (ESD) Procedure in Hyderabad at PACE Hospitals, under the expert care of the Gastroenterology Department.

The following steps were carried out during the procedure:

• Pre-Procedure Preparation: The patient was assessed for anesthetic fitness and cardiovascular stability. Informed consent was obtained after discussing the procedure, its risks, and benefits. Adequate bowel preparation was ensured, intravenous access was secured, and sedation administered along with prophylactic antibiotics.

• Diagnostic Colonoscopy: A diagnostic colonoscopy was performed to locate the polyps. A pedunculated polyp measuring 1×1 cm was identified in the ascending colon, and a diminutive polyp at the hepatic flexure was noted. External hemorrhoids were also documented. The size, morphology, and attachment of each lesion were assessed to guide resection.

• Submucosal Lifting: Submucosal injection of saline with sympathomimetic agent and dye was performed beneath the pedunculated polyp to lift the lesion and facilitate safe excision. This step separated the polyp from the underlying muscularis propria and minimized the risk of perforation or bleeding.

• Endoscopic Resection: The pedunculated polyp was excised using a snare with electrocautery (EMR). The diminutive polyp was removed en bloc via Endoscopic Submucosal Dissection (ESD) using specialized knives. Continuous hemostasis was maintained with coagulation forceps and endoscopic clips as needed.

• Specimen Retrieval and Verification: All resected polyps were retrieved for histopathological evaluation. The resection sites were carefully inspected to ensure complete removal of the lesions and absence of immediate complications such as active bleeding or perforation.

Postoperatively, the patient was managed with intravenous fluids for hydration and maintenance of electrolyte balance. Measures were instituted to prevent and treat any potential infections. Gastrointestinal mucosal protection was ensured, and supportive care was provided to aid recovery and maintain hemodynamic stability. Histopathology of the excised colonic polyp revealed features suggestive of tubular adenoma with low-grade dysplasia, with no evidence of high-grade changes or invasive cancer.

The patient remained stable, tolerated oral intake well, and showed symptomatic improvement, allowing for safe discharge with appropriate follow-up instructions.

The patient was discharged with medications for the management of chronic constipation, control of blood sugar levels, treatment of benign prostatic hyperplasia, and management of systemic inflammation related to psoriatic arthritis. Therapy was also continued for cardiovascular risk reduction, gastrointestinal symptom relief, and supportive supplementation as required. Instructions were provided for adherence to prescribed dosages and timing to ensure optimal control of underlying conditions and to support postoperative recovery.

The patient was advised to follow a high-fiber diet to support bowel regularity, along with a diabetic diet to help maintain optimal blood sugar control.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, abdominal pain, or vomiting.

The patient was advised to return for a follow-up visit with the Gastroenterologist in Hyderabad at PACE Hospitals after 1 week to review progress and consider initiation of antiplatelet therapy, and to review with the Endocrinologist after 1 week in view of diabetes.

This case highlights the successful removal of colonic polyps using EMR and ESD, providing a minimally invasive solution with reduced recovery time. Comorbid conditions were carefully managed, and the procedure was uneventful. Multidisciplinary evaluation and tailored follow-up ensured optimal patient outcomes.