Background and Study Aims: The endoscopic polypectomy of large pedunculated polyps can have serious complications,
such as hemorrhage, which has an incidence of about 2 %. We describe here a new, safe,
and effective technique of endoscopic polypectomy for the treatment of large pedunculated
colorectal polyps using a standard detachable diathermic snare.
Patients and Methods: 35 patients (18 men, 12 women; mean age 67.3, range 35 - 82), with 43 pedunculated
colorectal polyps, of benign appearance and of size 3 cm or larger (range 3 - 5 cm)
on colonoscopy, were included in our study. The polypectomy was performed in two steps:
a) we first placed a polypectomy snare round the middle of the stalk, as a prophylactic
measure to prevent postpolypectomy bleeding, and we then took out the colonoscope
without removing the snare after dismantling it and blocking with a clip; b) endoscopic
polypectomy was done using a second polypectomy snare, and transecting the stalk of
the polyps at 2 mm above the first snare. The first polypectomy snare was left in
place, and the patients were discharged within 3 hours of endoscopic polypectomy.
The first polypectomy snare sloughed off spontaneously and slipped down the anus,
being evacuated within 4 days following the endoscopic polypectomy.
Results: The ensnared polyps were located in the rectosigmoid region (n = 27), and the descending
(n = 13) and transverse colon (n = 3). Complete ensnarement of the head of the polyp
with a single endoscopic treatment was obtained in all cases. In addition, no procedural
or delayed bleeding was noted during a 6-month follow-up.
Conclusions: Our technique allows us to overcome the risk of bleeding, since the use of a standard
diathermic snare makes it easier to obtain optimal tightness. Moreover, this technique
is cheaper than the use of the standard detachable snare currently available (the
cost of the snares being $50.52 compared with $189.47).
References
- 1
Gossum A V, Cozzoli A, Adler M, et al.
Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of
current.
Gastrointest Endosc.
1992;
38
472-475
- 2
Rosen L, Bub D S, Reed J FIII, Nastasee S A.
Hemorrhage following colonoscopic polypectomy.
Dis Colon Rectum.
1993;
36
1126-1131
- 3
Pontecorvo C, Pesce G.
The “safety snare” - a ligature-placing snare to prevent haemorrhage after transection
of large pedunculated polyps.
Endoscopy.
1986;
18
55-56
- 4
Hachisu T.
A new detachable snare for hemostasis in the removal of large polyps or other elevated
lesions.
Surg Endosc.
1991;
5
70-74
- 5
Iishi H, Tatsuta M, Narahara H, et al.
Endoscopic resection of large pedunculated colorectal polyps using a detachable snare.
Gastrointest Endosc.
1996;
44
594-597
- 6
Matsushita M, Hajiro K, Takakuwa H, et al.
Ineffective use of a detachable snare for colonoscopic polypectomy of large polyps.
Gastrointest Endosc.
1998;
47
496-499
- 7
Frühmorgen P, Demling L.
Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of
Germany: results of an inquiry.
Endoscopy.
1979;
2
146-150
- 8
Shirai M, Nakamura T, Matsuura A, et al.
Safer colonoscopic polypectomy with local submucosal injection of hypertonic saline-epinephrine
solution.
Am J Gastroenterol.
1994;
89
334-338
- 9
Rex D K, Lewis B S, Waye J D.
Colonoscopy and endoscopic therapy for delayed post-polypectomy hemorrhage.
Gastrointest Endosc.
1992;
38
127-129
- 10
Slivka A, Parsons W G, Carr-Locke D L.
Endoscopic band ligation for treatment of postpolypectomy hemorrhage.
Gastrointest Endosc.
1994;
40
230-232
- 11
Iida Y, Miura S, Munemoto Y, et al.
Endoscopic resection of large colorectal polyps using a clipping method.
Dis Colon Rectum.
1994;
37
179-180
A. Tursi,M.D.
Department of Emergency
“L. Bonomo” Hospital
Galleria Pisani, 4
70031 Andria (BA)
Italy
Fax: + 39-0883-290225
Email: antotursi@tiscalinet.it
