Endoscopic resection using the Clutch Cutter and a detachable snare for large pedunculated colonic polyps

Abstract

Background and study aims Endoscopic snare polypectomy with prophylactic detachable snare of large pedunculated colonic polyps (PCPs) is technically demanding. To facilitate removal of such polyps, we developed endoscopic resection using the Clutch Cutter and a detachable snare (ERCCDS). This study aimed to evaluate the efficacy and safety of the procedure.

Patients and methods From April 2010 to July 2015, 14 consecutive patients who had PCPs with head > 10 mm, stalk width > 5 mm, and stalk length > 10 mm were enrolled in this single-center prospective uncontrolled study. They were treated using ERCCDS by a single endoscopist. The efficacy and safety were assessed using a database prospectively formatted from the medical records.

Results The Clutch Cutter was able to cut the distal side of the stalk an adequate distance from the detachable snare under good visual control. R0 resections were obtained in all lesions. There were no immediate or delayed complications.

Conclusions ERCCDS appears to be a safe, easy, and technically efficient method for large PCPs, although larger studies are needed to compare ERCCDS and standard resection.

• References

• 1 Tholoor S, Tsagkournis O, Basford P. et al. Managing difficult polyps: techniques and pitfalls. Annals of Gastroenterology 2013; 26: 114-121
• 2 Dobrowolski S, Dobosz M, Babicki A. et al. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc 2006; 63: 1004-1009
• 3 Dominitz JA, Eisen GM, Baron TH. et al. Complications of colonoscopy. Gastrointest Endosc 2003; 57: 441-445
• 4 Ji JS, Lee SW, Kim TH. et al. Comparison of prophylactic clip and endoloop application for the prevention of postpolypectomy bleeding in pedunculated colonic polyps: a prospective, randomized, multicenter study. Endoscopy 2014; 46: 598-604
• 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 Hachisu T. A new detachable snare for hemostasis in the removal of large polyps or other elevated lesions. Surg Endosc 1991; 5: 70-74
• 7 Akahoshi K, Kojima H, Fujimaru T. et al. Grasping forceps-assisted endoscopic resection of large pedunculated GI polypoid lesions. Gastrointest Endosc 1999; 50: 95-98
• 8 Tada S. A case of complication using hemostatic detachable snare [in Japanese]. Stomach Intest 1996; 31: 106-108
• 9 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
• 10 Akahoshi K, Akahane H, Motomura Y. et al. A new approach: Endoscopic submucosal dissection using the Clutch Cutter for early stage digestive tract tumors. Digestion 2012; 85: 80-84
• 11 Akahoshi K, Honda K, Kubokawa M. et al. Endoscopic resection of a large pedunculated duodenal polyp using a grasping type scissors forceps. Endoscopy 2008; 40: E74-E75
• 12 Di Giorgio P, De Luca L, Calcagno G. et al. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study. Endoscopy 2004; 36: 860-863
• 13 Dobrowolski S, Dobosz M, Babicki A. et al. Prophylactic submucosal saline-adrenaline injection in colonoscopic polypectomy: prospective randomized study. Surg Endosc 2004; 18: 990-993