ENDOSCOPIC RESECTION OF LARGE PEDUNCULATED COLORECTAL POLYPS USING A DETACHABLE SNARE

Background: Colonoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter is difficult because of the risk of bleedin g. To minimize this complication, we used a detachable snare that allo wed endoscopic ligation of the stalk of a large pedunculated polyp and evaluated its safety and effectiveness in comparison with conventiona l endoscopic snare polypectomy. Methods: Patients with pedunculated po lyps with heads 1 cm or greater in diameter were randomly assigned to colonoscopic polypectomy with (N = 47) or without (N = 42) a detachabl e snare. Arterial pumping bleeding immediately after colonoscopic poly pectomy or hematochezia resulting in a 10% or greater drop in hematocr it was defined as ''bleeding.'' Results: No bleeding occurred during o r after polypectomy with a detachable snare, but bleeding occurred sig nificantly more frequently (five patients, 12%) without a snare. Moreo ver, the use of a detachable snare reduced the duration of hospitaliza tion after polypectomy. Conclusions: Colonoscopic polypectomy with a d etachable snare may be safer than conventional polypectomy without a d etachable snare for resection of large, pedunculated polyps.