Darina Kohoutova, MD, PhD,^(1,2) and Bjorn J. Rembacken, MD,⁽²⁾ present this VideoGIE case “Trick for endoloop positioning before polypectomy by using a double-channel gastroscope.”

As post-polypectomy bleeding is the most common adverse event of polypectomy, various preventive techniques for how to decrease this risk have been developed for daily endoscopy practice. Placement of ligating loop belongs to one of these methods, but its placement at the base of the pedunculated polyps might be difficult to master. We have shown this new technique, which results in an accurate placement of the endoloop.

We used a double-channel gastroscope and  after a precise assessment of the polyp and its base we placed the endoloop through the left channel of the endoscope around the head of the polyp. The snare, inserted through the right channel, grasped the head of the polyp and allowed the ligating loop to be deployed at the base of the polyp stalk precisely. Finally, the snare was loosened and the polyp was removed accordingly. We avoided the postpolypectomy haemorrage by precise placement of the ligating device.

We wanted to offer an option to the endoscopists how to solve a situation when the placement of the ligating loop is difficult.

Endoscopists may use this technique with benefit especially if the head of the polyp is large and/or the lumen is narrow such as in the left colon. Bleeding in the sigmoid colon can be particularly challenging, as the narrow lumen fills with blood quickly, obscuring views.

Our technique leads to a reliable and fast placement  of the endoloop and results in reduction of postpolypectomy hemorrhage.

Author affiliations: (1): 2nd Department of Internal Medicine – Gastroenterology, Charles University in Praha, Faculty of Medicine at Hradec Kralove, University Teaching Hospital, Hradec Kralove, Czech Republic. (2):  St. James University Hospital, Department of Gastroenterology, Leeds, United Kingdom.

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