Chia-Wei Yang1, Hsu-Heng Yen, Yang-Yuan Chen, Maw-Soan Soon. 1. *Department of Gastroenterology, Changhua Christian Hospital, Changhua †School of Medicine, Chung-Shan Medical University, Taichung City ‡Department of Gastroenterology, China Medical University Hospital, Taichung City, Taiwan.
Abstract
BACKGROUND: Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyps are so large that it is either not possible or too difficult to resect them using a conventional polypectomy snare. AIM: To facilitate the removal of pedunculated colorectal polyps, we developed a new technique using a combination of a dual knife and preventive hemostatic procedures. METHODS: Nine patients (5 men and 4 women; mean age, 59.8 y; range, 49 to 79 y) with pedunculated polyps >2 cm in diameter were treated with this technique. A dual knife and endoclips or an endoloop were used as needed. RESULTS: All lesions, except for 1 polyp, were resected endoscopically. The mean time for complete resection was 8.5 minutes (range, 1.5 to 16 min). The procedure time decreased significantly after the fifth case (168 vs. 746 s, P=0.0009). No hemorrhage, perforation, or other complications occurred during follow-up among the endoscopically resected cases. CONCLUSIONS: Combined use of a dual knife and prophylactic hemostatic procedures is a feasible alternative technique for removing large pedunculated colorectal polyps when conventional snare resection is impossible or difficult.
BACKGROUND: Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyps are so large that it is either not possible or too difficult to resect them using a conventional polypectomy snare. AIM: To facilitate the removal of pedunculated colorectal polyps, we developed a new technique using a combination of a dual knife and preventive hemostatic procedures. METHODS: Nine patients (5 men and 4 women; mean age, 59.8 y; range, 49 to 79 y) with pedunculated polyps >2 cm in diameter were treated with this technique. A dual knife and endoclips or an endoloop were used as needed. RESULTS: All lesions, except for 1 polyp, were resected endoscopically. The mean time for complete resection was 8.5 minutes (range, 1.5 to 16 min). The procedure time decreased significantly after the fifth case (168 vs. 746 s, P=0.0009). No hemorrhage, perforation, or other complications occurred during follow-up among the endoscopically resected cases. CONCLUSIONS: Combined use of a dual knife and prophylactic hemostatic procedures is a feasible alternative technique for removing large pedunculated colorectal polyps when conventional snare resection is impossible or difficult.