Endoloop-assisted colon polypectomy

A 48-year-old man was addressed for endoscopic evaluation of chronic pain of the left lower quadrant. Gastroscopy was unrevealing. However, colonoscopy disclosed a villous-like pedunculated polyp of the sigmoid colon, 2.5cm in diameter, with fresh blood distally to it. Due to its size and to the high risk of bleeding, we decided to remove it by means of the endoloop technique.

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Endoloop-assisted colon polypectomy

Authors

Gf Donatelli, G Mavrogenis, S Perretta, B Dallemagne, J Marescaux

Abstract

A 48-year-old man was addressed for endoscopic evaluation of chronic pain of the left lower quadrant. Gastroscopy was unrevealing. However, colonoscopy disclosed a villous-like pedunculated polyp of the sigmoid colon, 2.5cm in diameter, with fresh blood distally to it. Due to its size and to the high risk of bleeding, we decided to remove it by means of the endoloop technique.

Keywords

Endoloop-assisted colon polypectomy

Media type

Surgical video

Duration

02'00''

Publication

2011-05

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E-publication

WeBSurg.com, May 2011;11(05).
URL: http://www.websurg.com/doi-vd01en3341.htm

Endoloop-assisted colon polypectomy

1. Introduction 00'18''

A 48-year-old man was addressed for endoscopic evaluation of chronic pain of the left lower quadrant. Gastroscopy was unrevealing. However, colonoscopy disclosed a villous-like pedunculated polyp of the sigmoid colon, 2.5cm in diameter, with fresh blood distally to it. Due to its size and to the high risk of bleeding, we decided to remove it by means of the endoloop technique.

2. System details 00'45''

The detachable endoloop system is composed of an operating part and an attached loop. Before use, the loop is retracted inside the plastic sheath for insertion through the accessory channel of the colonoscope.

3. Polypectomy with the Endoloop 00'59''

The endoloop is extended and applied at the base of the stalk. It is then tightened around the stalk by sliding the stopper and finally detached from the operating part. The change of the color of the polyp, due to the ischemia, ensured sufficient tightening. Next, the base of the polyp is elevated with injection of normal saline solution with diluted epinephrine (1:10 000) and indigo carmine in order to diminish the perforating risk, the bleeding risk as well as help to distinguish the submucosa from the mucosa. A diathermic snare is then used to sever the stalk of the polyp above the tightened loop using electrosurgical coagulation current. During cutting, it is crucial to avoid the contact of the polyp’s head to the colonic wall since the temperature that is transmitted may provoke colonic perforation. The patient was discharged the day after the procedure. Neither bleeding nor perforation occurred. The histology concluded to the existence of a tubulovillous adenoma with low-grade dysplasia. The resection was complete. In conclusion, the endoloop-assisted polypectomy, when feasible, is a safe technique to prevent bleeding.