Insulated-tip knife endoscopic polypectomy for difficult pedunculated colorectal polyps: a prospective pilot study

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Conventional endoscopic polypectomy poses challenges for giant pedunculated colorectal polyps (≥3 cm).
• En bloc resection of these large polyps often necessitates surgical intervention.
• Previous experience highlighted the potential of insulated-tip knife use for giant polyp removal.

Purpose of the Study:

• To evaluate the safety and feasibility of insulated-tip knife endoscopic polypectomy (IT-EP).
• To assess IT-EP as a treatment for difficult pedunculated colorectal polyps.
• To determine if IT-EP can obviate the need for surgery in these cases.

Main Methods:

• A prospective study enrolled seven consecutive patients with giant pedunculated colorectal polyps (≥3 cm).
• Insulated-tip knife endoscopic polypectomy (IT-EP) was performed with clip assistance for all patients.
• Data on procedure outcomes and patient follow-up were collected and analyzed.

Main Results:

• Seven patients (5 male, 2 female; mean age 61 years) with large polyps (mean head diameter 36.4 mm, stalk diameter 14.6 mm) were treated.
• All seven polyps were successfully removed using IT-EP within a mean operation time of 14.9 minutes.
• No serious complications (bleeding, perforation) occurred, and no patient required surgery. Follow-up showed no recurrence.

Conclusions:

• Insulated-tip knife endoscopic polypectomy (IT-EP) is a safe and feasible endoscopic treatment.
• IT-EP provides an effective alternative for managing difficult pedunculated colorectal polyps.
• The technique successfully avoids surgical transfer and demonstrates good long-term outcomes.