Removing a large pedunculated colonic polyp using a loop anchored with clips at the root

Compared with conventional polypectomy after adrenaline injection, loop-assisted polypectomy is considered more effective and has less post-procedural bleeding in endoscopic resection of large pedunculated colonic polyps [1]. However, postpolypectomy bleeding still exists after loop-assisted polypectomy because the loop slips off the stalk or a thin stalk is transected by the loop after polypectomy [2]. We used two clips to fasten the loop at the root to avoid the stalk slipping or transecting in a large pedunculated colonic polyp. Moreover, we removed the polyp successfully without postpolypectomy bleeding, and the stalk disappeared one month later.

A 27-year-old woman presented with a large pedunculated polyp at the sigmoid colon ([Video 1], [Fig. 1]). Two clips were used to fasten the loop ring at the root of the pedunculated polyp ([Video 1]). We then tightened and released the loop ([Fig. 2]). The whitened polyp was shown. A hot snare was used to entrap the root above the loop and resect the polyp intactly. The polyp measured approximately 3.5 × 3 cm ([Fig. 3]). The white wound displayed ([Fig. 4]). Two clips were used to close the wound. Histopathologic examination showed the large pedunculated polyp was a villous tubular adenoma without a residual tumor at the pedicle. The patient had no postpolypectomy bleeding. One-month follow-up showed the wound was clear and the pedicle had disappeared ([Fig. 5]).

Removing a large pedunculated colonic polyp by clip-anchored loop at the root.Video 1

Fig. 1 A large pedunculated polyp at the sigmoid colon.

Fig. 2 Clip-anchored loop at the root of the large pedunculated polyp.

Fig. 3 The specimen of the large pedunculated polyp.

Fig. 4 The white wound after the large polyp was removed.

Fig. 5 The follow-up wound with disappeared pedicle after one month.

Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AB

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Kouklakis G, Mpoumponaris A, Gatopoulou A. et al. 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
• 2 Katsinelos P, Kountouras J, Paroutoglou G. et al. Endoloop-assisted polypectomy for large pedunculated colorectal polyps. Surg Endosc 2006; 20: 1257-1261

Publikationsverlauf

Artikel online veröffentlicht:
21. März 2025