Endoscopic submucosal dissection‐like grasping scissor forceps resection of a pedunculated colorectal lesion with high‐grade fibrosis complicating aborted hot snare polypectomy

Abstract

AbstractHot snare polypectomy (HSP) remains the reference standard in endoscopic resection of pedunculated colorectal lesions. Notwithstanding, in some unique instances, such as giant Paris Ip lesions, difficult‐to‐access stalks and/or high‐grade fibrosis, alternative resection techniques might be more appropriate to ensure wide‐margin en bloc resection. In a unique 55‐year‐old patient office‐based HSP performed elsewhere was aborted during electrosurgical snaring due to intraprocedural bleeding complications. Due to marked ring‐like fibrosis at the base of the small‐stalked pedunculated lesion, we opted for an endoscopic submucosal dissection (ESD)‐like approach, utilizing a grasping scissor forceps device (ClutchCutter, Fuji). With a procedure time <10 min en bloc and R0 resection of a low‐grade intraepithelial neoplasia was accomplished without difficulties. To the best of our knowledge, this report is unique and altogether novel for several reasons, including abortion of preceding HSP with high‐grade fibrosis and ESD‐like grasping scissor forceps resection as an innovative endoscopic bailout in such unreported setting.