CUTTING DELAY DURING POLYPECTOMY OF A LARGE PEDUNCULATED POLYP IN THE CAECUM – USE OF A PARTIALLY ISOLATED SNARE

A 69-year old female patient was submitted for endoscopic resection of a large pedunculated polyp in the caecum. After submucosal injection with 10 ml of diluted epinephrine solution, a braided wire snare (25 mm, Olympus-Europe, Hamburg, Germany) was placed around the lesion. Cutting with the HF Unit ERBE VIO 300 (ERBE-Elektromedizin, Tübingen, Germany) was started with EndoCUT Q Effect 3, however, no cutting current could be established at the polyp stalk.

Therefore we changed to a partially isolated polypectomy snare with 30 mm (Micro-Tech Europe, Düsseldorf, Germany). The HF generator was set to Auto Cut and the polyp could be resected in one piece. After the endoscopic treatment, an active bleeding could be controlled with through-the-scope clips.

The histopathological diagnosis showed high-grade dysplasia with an R0 resection.

Conclusion:

Complete resection of large pedunculated polyps could involve the risk of a cutting delay. Partially isolated snares could be an answer because the current in the cutting wire is strongly reduced. Attention has to be payed to postinterventional bleeding.