INEFFECTIVE USE OF A DETACHABLE SNARE FOR COLONOSCOPIC POLYPECTOMY OFLARGE POLYPS

Background: Colonoscopic polypectomy of large polyps may be associated with complications such as bleeding. Use of a detachable snare may re duce the risk of bleeding. We describe several instances in which the use of such a device proved to be ineffective. Methods: A detachable s nare was used for colonoscopic polypectomy of large polyps in 18 patie nts (20 polyps), also applied at the residual stalk after conventional polypectomy in 5 patients (5 polyps), and evaluated retrospectively. Results: Sixteen of the 20 polyps were pedunculated, and 4 were semi-p edunculated. In 3 of the 4 semi-pedunculated lesions, the loop slipped off after polypectomy because the lesions were cut close to the site of encirclement. Bleeding occurred in 4 cases because of transection b y the loop of a thin stalk (4 mm) before polypectomy (1), slipping of the loop in a semi-pedunculated lesion (1), or insufficient tightening of the loop (2). After conventional polypectomy, we could not effecti vely snare the residual stalk because of flattening in 3 of the 5 lesi ons. Conclusions: Use of the detachable snare for polypectomy of thin stalked or semi-pedunculated lesions may result in technical failure o f this technique. The stalk should be fully encircled with the snare b efore polypectomy. The detachable snare is difficult to apply at the r esidual stalk after conventional polypectomy.