Insulated-tip knife endoscopic resection

Dr. LinghuEnqiang Linghu, MD from the Chinese PLA General Hospital in Beijing, China presents this video case “Insulated-tip knife endoscopic resection of a giant pedunculated colon polyp” from the VideoGIE section.

Our video introduced a novel but feasible method with insulated-tip (IT) knife to remove a giant pedunculated colon polyp. The polyp, approximately 4cmx 4cm in size with a 2.5cm-long, 1.2cm-thick stalk, almost completely blocked the lumen. Conventional endoscopic polypectomy, be it with a snare or an endoloop, is insufficient for successful en bloc resection due to the large polyp head. We firstly applied bi-directionally two long clips (Resolution; Boston Scientific) to the stalk for blood occlusion. Visually, the stalk was cut off successfully with IT knife. Finally, a prophylactic endoloop was further placed around the residual stalk. The patient was uneventful and no recurrence was found during a 6-month follow-up.

We thought well vision of the stalk in suitable position and effective clipping were the key to the operation. Meanwhile, take care to keep enough distance from clips to avoid potential conductive electric injury.

Large pedunculated colonic polyps carry a higher risk of bleeding for polypectomy due to considerable vessels in the stalks. For those with giant heads in which conventional snare polypectomy was incapable,  piecemeal resection was the only endoscopic treatment but contributed to a greatly increased risk of bleeding, as well as imprecise pathologic assessment. Usually, surgery has to be considered as the first choice. In this presentation, IT knife endoscopic resection appeared to be a good alternative. Compared to resection with dual knife or needle knife, IT knife appears to be much safer and more friendly to operators in the narrow space because the ceramic ball provided not only stable capture and gradual incision of the stalk, but prevention of accidental colonic wall injury. We believe the technique is safe and feasible to remove large pedunculated colon polyps.

Figure 1Figure 1. A, A giant pedunculated polyp in the sigmoid colon, 4 cm 4 cm in size with a 2.5-cm–long, 1.2-cm–thick stalk. B, Two long clips were bidirectionally placed on the stalk about 5 mm above the base. C, The stalk was cut with an insulated-tip knife about 7 mm away from the clips to avoid potential conductive electric injury. D, To further prevent bleeding, an Endoloop was placed around the residual stalk.

Find more VideoGIE cases online here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

 

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