1494 Padlock Clip in the Management of Non-Lifting Part of Incompletely Resected Polyp With Central Fibrosis

Abstract

INTRODUCTION: Removing nonlifting colon polyps with fibrosis secondary to prior intervention could be challenging. The novel over-the-scope Padlock clip was used in esophageal fistulas, refractory gastrointestinal bleeding, and GI defects closure. In this study, we describe our experience with Padlock clip in remeoving nonlifitng colon polyp. CASE DESCRIPTION/METHODS: A 69-year-old man is referred to our clinic to assist in the management of partially excised large, non-granular, broad-based Tubulovillous adenoma. The polyp was in cecum and measured about 5 cm. The patient underwent surveillance colonoscopy given personal history of colon polyps and paternal history of colorectal cancer. The referring physician attempted to remove by standard and Captivator snares using hot snare techniques. The polyp was not completely engaged, and the resected fragments were removed using roth net. We attempted to lift the polyp to remove using endoscopic submucosal dissection, but the scar mark could not be lifted. After marking around the polyp using electrosurgical knife (Figure 1), endoscopic submucosal dissection was done around the polyp with gradual extension of the circumferential mucosal incision, followed by hot snare-assisted resection of the lesion in a piecemeal fashion. The Non-lifting part of mucosal polyp was then grasped with raptor grasping device and Padlock clip was deployed on the polyp. The remnant polyp was successfully removed with hot snare utilizing “histlock resection device” and the margins were treated with tip of hot snare (Figure 2). Repeat colonoscopy after 3 months showed scar at previous polypectomy site with clean margins and no signs of recurrence (Figure 3). DISCUSSION: To our knowledge, this is the first study describing the use of of Padlock clip in the management of nonlifting colon polyp after incomplete resection using the conventional methods. The Padlock clip was used in the management of refractory gastrointestinal bleeding (post endoscopic mucosal resection, solitary rectal ulcer, and duodenal dieulafoy lesion), broncho-esophageal and tracheoesophageal fistulas closure, and wall defects closure in porcine. Further prospective studies are needed to assess its use in removing incompletely resected polyps.