Video Related to this Article
- •Colonoscope: CF H180AL (Olympus America, Inc., Center Valley, PA, USA).
- •Snare: AcuSnare Polypectomy Snare 1.5 cm × 3 cm (Cook Medical, Bloomington, IN, USA).
- •Single-use ligating device: Polyloop (Olympus America, Inc.).
Background and Endoscopic Procedure
Key Learning Points/Tips and Tricks
- •Use of endoloop-assisted polypectomy of large pedunculated polyp prevents postpolypectomy bleeding.
- •The position of the endoloop on the stalk should be at some distance from the lower edge of the polyp so that polypectomy can be performed above the endoloop.
- •The tightened endoloop around the stalk acts like a tourniquet, thereby tamponading the vessel in the pedicle.
- •The correct positioning of the endoloop with polypectomy leads to clear stalk margin.
Complications and Risk Factors
- •Immediate and delayed postpolypectomy bleeding.
- •Colonic perforation.
- •Postpolypectomy syndrome.
Alternatives to the Procedure
- •Endoscopic surveillance without removing the polyp.
- •Surgical resection.
|Time (min:sec)||Voiceover script|
|00:00–00:15||This video shows a 2.5 cm pedunculated polyp in the rectosigmoid that has a thick pedicle which usually has a feeding vessel.|
|00:16–00:23||To prevent bleeding we apply a loop ligating device like endoloop that acts as a tourniquet.|
|00:24–00:40||Here you see that the endoloop is opened and negotiated around the polyp and brought down to the pedicle.|
|00:41–00:51||Endoloop is positioned on the stalk some distance away from the lower edge of polyp.|
|00:52–01:08||After endoloop is in a good position it is tightened and then released. The tightened endoloop tamponades the vessel in pedicle.|
|01:12–01:32||A snare is passed and manipulated to bring it down over the polyp stalk.|
|01:33–01:41||The snare is then tightened above the endoloop and polypectomy performed.|
|01:42–01:48||After polypectomy, the endoloop is still tightly secured.|
|01: 49–end||This patient did well and did not have any post polypectomy bleeding. The histopathology of the polyp showed tubulovillous adenoma and a clear stalk margin.|
- Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths.N. Engl. J. Med. 2012; 366: 687-696
- Clinicopathologic Features and Endoscopic Treatment of Superficially Spreading Colorectal Neoplasms Larger than 20 mm.Gastrointest. Endosc. 2001; 54: 62-66
- Endoscopic Resection of Large Pedunculated Colonic Polyps and Risk of Postpolypectomy Bleeding with Adrenaline Injection Versus Endoloop and Hemoclip: A Prospective, Randomized Study.Surg. Endosc. 2009; 23: 2732-2737
- Endoclip-Assisted Resection of Large Pedunculated Colorectal Polyps: Technical Aspects and Outcome.Dig. Dis. Sci. 2010; 55: 1726-1731
- Anchor Clip Technique Helps in Easy Prevention of Post-Polypectomy Hemorrhage of Large Colonic Polyps.Dig. Endosc. 2010; 22: 366-369
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