DOUBLE SNARE METHOD POLYPECTOMY

Abstract

Among problems often encountered with high-frequency-current-applied endoscopical polypectomy, such as leakage of electricity, electric shock, bleeding, perforation, burns, intra-colonic gas burst etc., the most difficult to cope with are unpedictable profuse bleeding and perforation. With the intension to establish a reliable formula for controlling such major bleeding and concomitant fateful perforation, the present authors developed a double-snare method polypectomy. That is: through one channel of the 2-channel fiberscope, a venyl-insulated wire-loop snare for strangulation to stem blood flow is first set on the stalk of a polyp at its base. Another wire-loop snare to work as a scapel is led throuth the other channel to take its place where to cut stalk, some millimeters away up in parallel with the first strangulating snare. After polypectomy, stragulation with the snare is gradu9lly loosened to confirm no more bleeding from the cut-site of the stalk. If bleeding remains persistent, the strangulating snare is again tightend to stop the bleeding, and some hemostatic method is applied using electrocoagulation, hemostatic clip or pure ethanol injection; either will be applied via the second channel (Fig. 2). In 37 patients receiving the double-snare polypectomy, since 1975 for a total of 40 gastric polyps and one colonic polyp over 15 mm in largest diameter. Profuse bleeding was noted from the cut-site of the stalk in 7 polyps. Resumed tightening of the strangulating snare and any hemostatic method shown in Fig. 2 was selected. Bleeding could be stopped in all cases. In another distinctive advantage, the method, with the application of a special technique, can turn a sessile polyp to a pedunculated one, thus making easier approach possible (Fig. 3). This may will be cited as another merit of the new method, capable of minimizing a high-risk of perforation especially in colonic polypectomy.