Handcrafted two-channel colonoscope for grasping forceps-assisted resection of large pedunculated polyps in the sigmoid colon

We read with interest the article by Yang and Yen [1] on combined biopsy forceps and scissor forceps for cutting an endoloop entrapped in a large pedunculated polyp in the sigmoid colon. The endoloop could not be cut with a scissor forceps because it easily slipped away from the blades. The endoloop was removed successfully by using a two-channel endoscope to combine biopsy forceps for grasping the endoloop and scissor forceps for cutting the endoloop. Although the polyp was finally resected after application of an additional endoloop, we recommend the initial use of a two-channel endoscope in such patients.

Endoscopic removal of large polyps is technically difficult and has the increased risk of bleeding or perforation. Large colonic polyps occlude the intestinal lumen, which makes it difficult to snare over the polyps [2] [3]. For safe endoscopic removal of large polyps, the application of an endoloop offers the most advantage by securing the base of polyps before transection [2] [3]. However, an endoloop may be ineffective, especially when there is a large polyp in a limited space in the sigmoid colon [2] [3] [4], as in the patient described by Yang and Yen [1].

To facilitate removal of large pedunculated polyps, Akahoshi et al. [2] developed grasping forceps-assisted endoscopic resection to reduce technical difficulty and the incidence of complications. After grasping the polyp and applying an endoloop with a two-channel endoscope, large pedunculated polyps are easily snared and safely removed. Because a two-channel endoscope is not available in all hospitals, we devised a simple and inexpensive way to handcraft a two-channel endoscope by taping a plastic tube along the shaft of a standard colonoscope [3] [5]. This handcrafted device was used for grasping forceps-assisted resection of large pedunculated polyps, resulting in excellent outcomes [3].

We therefore believe that large pedunculated polyps would be removed safely without technical difficulty by the initial use of a handcrafted two-channel colonoscope for grasping forceps-assisted resection. The colonoscope can be handcrafted easily and is therefore available in all hospitals.

• References

• 1 Yang C-W, Yen H-H. Combined biopsy forceps and scissor forceps facilitate cutting the detachable loop entrapped in a large pedunculated polyp. Endoscopy 2012; 44: E202-E203
• 2 Akahoshi K, Kojima H, Fujimaru T et al. Grasping-forceps-assisted endoscopic resection of large pedunculated GI polypoid lesions. Gastrointest Endosc 1999; 50: 95-98
• 3 Matsushita M, Takakuwa H, Matsubayashi Y et al. Handcrafted two-channel colonoscope for grasping-forceps-assisted resection of giant pedunculated polyps. Gastrointest Endosc 2005; 62: 132-136
• 4 Matsushita M, Hajiro K, Takakuwa H et al. Ineffective use of a detachable snare for colonoscopic polypectomy of large polyps. Gastrointest Endosc 1998; 47: 496-499
• 5 Matsushita M, Danbara N, Shimatani M et al. Handcrafted two-channel colonoscope for removing large lipomas. Endoscopy 2007; 39: 84