Choking with a snare to control immediate bleeding after cold snare polypectomy

A 75-year-old man underwent surveillance colonoscopy after endoscopic submucosal dissection for an intramucosal adenocarcinoma in his transverse colon. Colonoscopy revealed a metachronous colonic polyp in the transverse colon ([Fig. 1 a]). Macroscopically, this was a type 0-IIa lesion and, according to the JNET classification [1], it was type 2A, indicating a low grade adenoma ([Fig. 1 b]). Therefore, we performed cold snare polypectomy (CSP) using the Snare Master Plus (10 mm; SD-400U-10, Olympus, Tokyo, Japan). Bleeding continued for 60 seconds after CSP (immediate bleeding; [Fig. 1 c]), therefore we choked the mucosal defect, including the surrounding mucosa, with the same snare ([Fig. 1 d]). We continued the choking for 30 seconds, which stopped the bleeding ([Fig. 1 e]; [Video 1]). There were no complaints of hematochezia thereafter. Pathologically, the polyp was a low grade tubular adenoma, with no involvement of the lesion at the cut margin.

Fig. 1 Colonoscopic views showing: a a 9-mm polyp (macroscopic type IIa) in the transverse colon; b a JNET type 2A lesion on narrow-band imaging, indicating a low grade adenoma; c immediate bleeding from the mucosal defect after cold snare polypectomy, which continued for 60 seconds; d choking of the mucosal defect with the snare; e the appearance after hemostasis had been achieved by choking with the snare.

Video 1 Immediate bleeding after cold snare polypectomy is controlled by choking with the snare.

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CSP is widely performed for subcentimeter polyps, where less delayed bleeding, coagulation syndrome, and perforation are expected [2] [3] [4] [5]. However, immediate bleeding sometimes occurs after CSP and hematochezia can cause anxiety [2] [3] [5]. In this case, choking with a snare enabled prompt and successful control of immediate bleeding, without the need to change to other devices, such as clips or hemostatic forceps.

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• References

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• 3 Shichijo S, Takeuchi Y, Kitamura M. et al. Does cold snare polypectomy completely resect the mucosal layer? A prospective single-center observational trial. J Gastroenterol Hepatol 2020; 35: 241-248
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