title: Ineffective use of a detachable snare for colonoscopic polypectomy of large polyps.
abstract: BACKGROUND
  Colonoscopic polypectomy of large polyps may be associated with complications such as bleeding. Use of a detachable snare may reduce the risk of bleeding. We describe several instances in which the use of such a device proved to be ineffective.
  
  
  METHODS
  A detachable snare was used for colonoscopic polypectomy of large polyps in 18 patients (20 polyps), also applied at the residual stalk after conventional polypectomy in 5 patients (5 polyps), and evaluated retrospectively.
  
  
  RESULTS
  Sixteen of the 20 polyps were pedunculated, and 4 were semi-pedunculated. In 3 of the 4 semi-pedunculated lesions, the loop slipped off after polypectomy because the lesions were cut close to the site of encirclement. Bleeding occurred in 4 cases because of transection by the loop of a thin stalk (4 mm) before polypectomy (1), slipping of the loop in a semi-pedunculated lesion (1), or insufficient tightening of the loop (2). After conventional polypectomy, we could not effectively snare the residual stalk because of flattening in 3 of the 5 lesions.
  
  
  CONCLUSIONS
  Use of the detachable snare for polypectomy of thin stalked or semi-pedunculated lesions may result in technical failure of this technique. The stalk should be fully encircled with the snare before polypectomy. The detachable snare is difficult to apply at the residual stalk after conventional polypectomy.
authors.affiliation: Department of Gastroenterology, Tenri Hospital, Nara, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Matsushita
authors.forename: K
authors.initials: K
authors.lastname: Hajiro
authors.forename: H
authors.initials: H
authors.lastname: Takakuwa
authors.forename: F
authors.initials: F
authors.lastname: Kusumi
authors.forename: T
authors.initials: T
authors.lastname: Maruo
authors.forename: M
authors.initials: M
authors.lastname: Ohana
authors.forename: M
authors.initials: M
authors.lastname: Tominaga
authors.forename: A
authors.initials: A
authors.lastname: Okano
authors.forename: Y
authors.initials: Y
authors.lastname: Yunoki
mesh_terms: D000368:Aged; D003111:Colonic Polyps / Q000601:surgery*; D020685:Colonoscopes; D019723:Endoscopes; D004724:Endoscopy / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies