Anchor clip technique helps in easy prevention of post-polypectomy hemorrhage of large colonic polyps

Abstract

Large colonic polyps have large vessels, which often cause post-polypectomy hemorrhage. Some of the stalks of large pedunculated polyps are formed by the weight of the polyps and disappear after polypectomy. There are some reports suggesting that pre-ligation with Endoloop(R) may minimize the risk of post-polypectomy hemorrhage. However, the current density increases more at the site of pre-ligation as compared with that at the site of polypectomy, because polypectomy is carried out with gradual snaring. This implies that burn injury may also occur at the site of pre-ligation, causing the loss of pre-ligation and, consequently, post-polypectomy hemorrhage. Ligation of stalks after polypectomy is very difficult. The Endoloop(R) rolls back when it is tightened, because of the lack of torsional stiffness. We have developed a simple and improved post-polypectomy ligation technique using the Anchor clip. Before polypectomy, an Endoclip(R) is placed partially at the base of the pedunculated polyp. When the stalk is tightened completely with the Endoclip(R) before polypectomy, burn injury occurs around the Endoclip(R) . The Anchor clip at the base of the pedunculated polyp holds the stalk after polypectomy and the constricted part formed by the Anchor clip prevents the rolling up of the Endoloop(R) and helps in easy ligation of the stalk. We have used the Anchor clip for 50 patients. Application of the Endoloop(R) after polypectomy was impossible in two patients. The remaining 48 patients underwent Endoloop(R) -assisted polypectomy with the Anchor clip, and in none of the cases did bleeding occur after polypectomy.