Endoscopic resection of large pedunculated colon polyps using only a scissor-type knife: a case series

All pedunculated colon polyps (PCPs) should ideally be resected en bloc for accurate histopathological evaluation. However, maneuvering a snare around the large head of a pedunculated polyp with a long, wide stalk can be technically challenging. In addition, clinically significant bleeding after snare polypectomy remains a legitimate concern. Small case series from Asia have supported the feasibility of endoscopic submucosal dissection (ESD) for the removal of these challenging large PCPs. However, ESD is not widely performed in the West because of its technical complexity, steep learning curve, and higher risk of adverse events when compared with conventional endoscopic mucosal resection. Our aim was to demonstrate the feasibility of performing en bloc resection of large PCPs using a scissor-type electrocautery ESD knife when conventional snare polypectomy is not feasible.

Two patients were found to have large PCPs with wide stalks. Attempts to maneuver a snare around the head of the PCP were unsuccessful, and the decision was to proceed with ESD using the scissor-type knife.

Both polyps were successfully resected en bloc using only the scissor-type knife. Both procedures were completed in under 20 minutes with no adverse events. Histopathology results of both polyps were consistent with tubulovillous adenoma with resection margins free of dysplasia, consistent with curative R0 resection.

En bloc resection of large PCPs can be challenging when it is difficult to maneuver the snare around the head of the polyp. In this video, we demonstrate how a dedicated scissor-type ESD knife can facilitate the resection of these lesions. The insulated rotatable blades of the scissor-type knife allow safe and precise dissection of the stalk under direct visualization, which further permits targeted hemostasis when needed. Future studies are needed to corroborate the efficacy and safety of this device for the resection of selected colorectal lesions.