Lumen filling giant pedunculated polyps can be challenging to resect and in some instances
can be impossible leading patients to have surgery. Difficulties in polypectomy include
an unstable position, large polyp head, unclear views and thick stalks. Here we describe
an endoscopic technique which salvaged a challenging polypectomy.
A 62 year old lady attended after presenting with Per Rectal bleeding and passage
of mucous. Initial colonoscopy showed a large pedunculated polyp with a pit pattern
of type 4/5 which was thought to be malignant. CT scan was normal. On repeat colonoscopy
there were no clear signs of malignancy. Despite numerous attempts it was impossible
to capture the polyp with conventional snares even after applying volume reduction.
Finally the polyp was resected by cutting the stalk using a SB Junior Knife (Scissors
forceps). Three prophylactic clips were applied. Patient did not have any complications.
This technique provides a useful option for performing polypectomy in challenging
stalked polyps and should form part of every endoscopist's armamentarium.
