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Surg Endosc (2007) 21: 16761677 DOI: 10.1007/s00464-007-9426-2
Springer Science+Business Media, LLC 2007
Endoloop-assisted polypectomy for large peduncolated colorectal polyps
We were very interested in reading the recent paper by Katsinelos et al. [1] regarding the technique of endoloop-assisted polypectomy in large pedunculated colorectal polyps. In summary, the Authors data suggest that although colonoscopic resection of large peduncuolated polyps using an endoloop is safe and eective, the problems encountered with this method show some of the limitations encountered with endoscopic therapy in preventing postpolypectomy bleeding when currently available instruments are used. Nevertheless, by reading and re-reading the paper: a) 33 patients with large pedunculated polyps were enrolled; b) four were excluded because of narrow sigmoid lumen and polyp head size, precluding endoloop placement; c) in one patient the endoloop entangled with the snare, precluding en-bloc resection; d) in the remaining 28 patients, two bled immediately because of inadvertent transection of the thin stalk (<4 mm) with the tightening of the endoloop, and two showed delayed bleeding because of slipping of the endoloop. In conclusion: a) in more than 12% of the case endoloop can not be placed; b) placement of the endoloop can preclude en-bloc resection of the polyp; c) in two cases (7.1%) the endoloop was the cause of bleeding, and in another two, the endoloop was not able to prevent delayed bleeding, thus, globally, bleeding occurred in four (14.3%) out of 28 patients. Taking into account that bleeding is reported to occur immediately in about two percent of the cases after snaring [2], bleeding caused by the endoloop (due to inadvertent transection of the stalk) in 7.1% of the cases suggests that the procedure is not safe. Moreover, taking into account that, globally, post-polypectomy...