Use of dual knife for large pedunculated colorectal polyps.

Abstract

Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyps are so large that it is either not possible or too difficult to resect them using a conventional polypectomy snare. To facilitate the removal of pedunculated colorectal polyps, we developed a new technique using a combination of a dual knife and preventive hemostatic procedures. Nine patients (5 men and 4 women; mean age, 59.8 y; range, 49 to 79 y) with pedunculated polyps >2 cm in diameter were treated with this technique. A dual knife and endoclips or an endoloop were used as needed. All lesions, except for 1 polyp, were resected endoscopically. The mean time for complete resection was 8.5 minutes (range, 1.5 to 16 min). The procedure time decreased significantly after the fifth case (168 vs. 746 s, P=0.0009). No hemorrhage, perforation, or other complications occurred during follow-up among the endoscopically resected cases. Combined use of a dual knife and prophylactic hemostatic procedures is a feasible alternative technique for removing large pedunculated colorectal polyps when conventional snare resection is impossible or difficult.