Endoscopic resection of large pedunculated colonic polyps using Endoloop. Three case reports and review of the literature

Endoscopic polypectomy is now an established procedure for the resection of colorectal polyps. One of the serious complications associated with colonoscopic polypectomy is hemorrhage. Several factors appear to be associated with increased risk of hemorrhage including patient age and colorectal polyp size, location, and morphology (thick stalk or sessile). In particular, resection of large polyps is associated with a higher risk of serious complications. Bleeding most often occurs within the first 24 hours. More than 95% of cases of bleeding can be treated endoscopically by epinephrine injection, heater probe, or band ligation, alone or in combination. Several methods have been proposed for the prevention of hemorrhage after polypectomy. The most interesting approach is the use of a detachable snare (Endoloop) which allows endoscopic ligation of the stalk of a large, pedunculated polyp. In order to avoid the more severe consequences of bleeding, we use a detachable snare in two patients with a pedunculated polyp with a large head and stalk (> 2 cm). In a third patient receiving anticoagulant, a detachable snare was chosen to safely and completely remove a large pedunculated polyp > 1.5 cm. In conclusion, colonoscopic polypectomy with Endoloop is safer than conventional polypectomy alone for resection of large, pedunculated polyps, especially in patients with liver disease, coagulopathy and receiving anticoagulant.