Endoloop-assisted polypectomy for large pedunculated colorectal polyps

Surg Endosc (2006) 20: 12571261DOI: 10.1007/s00464-005-0713-5 Springer Science+Business Media, Inc. 2006Endoloop-assisted polypectomy for large pedunculated colorectal

polypsP. Katsinelos,1 J. Kountouras,2 G. Paroutoglou,1 A. Beltsis,1 G. Chatzimavroudis,3 C. Zavos,2 I. Vasiliadis,1T. Katsinelos,1 B. Papaziogas31 Department of Endoscopy and Motility Unit, Central Hospital, Ethnikis Aminis 41, 546 35 Thessaloniki, Greece2 Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece3 Second Surgical Clinic, Aristotle University of Thessaloniki, Thessaloniki, GreeceReceived: 19 October 2005/Accepted: 14 March 2006/Online publication: 20 July 2006AbstractBackground: The use of an endoloop may minimize the

risk for bleeding after endoscopic polypectomy of large

colorectal polyps. This study aimed to assess the safety

and ecacy of colonoscopic ligation of the stalk of large

pedunculated polyps by means of an endoloop technique, and to focus particular attention on the instances

in which the use of this device was unsuccessful.

Methods: This study retrospectively evaluated attempted

endoloop endoscopic polypectomy in 33 patients

(19 men and 14 women; mean age, 62.5 years) with large

pedunculated polyps.Results: Application of the endoloop was impossible in

four patients, and the snare became entangled with the

loop in one patient. The remaining 28 patients underwent endoloop-assisted polypectomy. Bleeding occurred

in four patients, either because the loop slipped of the

stalk after polypectomy (2 patients) or because a thin

stalk ( 4 mm) was transected by the loop before

polypectomy (2 patients).Conclusion: Colonoscopic polypectomy with an endoloop may be safer than conventional polypectomy. The

reasons for technical failure of this technique include a

narrow left colon lumen, a thin stalk ( 4 mm), and

close cutting in relation to the site of encirclement by the

loop.Key words: Colonoscopic ligation Endoloop-assisted polypectomy Large colorectal polyps Large

pedunculated polypsPostpolypectomy bleeding is reported to occur in 2% of

all polypectomies. The risk of bleeding probably is

greater with large polyps that have thick stalks [13].

The other important complications, namely, postpolypectomy coagulation syndrome (0.51%) [4] and perforation (0.5%) [5] are less common. Bleeding can occur

in the immediate postpolypectomy period, or may be

delayed a few days [4] or up to 30 days [6].Several endoscopic techniques have been developed

to prevent bleeding. Injection of the stalk with epinephrine solution or sclerosants before transection is

recommended to diminish the risk of postpolypectomy

hemorrhage. However, epinephrine injection...