A new detachable snare for hemostasis in the removal of large polyps or other elevated lesions

Abstract

In cooperation with Olympus Optical Co. (Tokyo, Japan) the author developed a detachable snare that enables the endoscopic ligation of the base of an elevated lesion. This apparatus surrounds the base of a large polyp or other elevated lesions with a specially manufactured loop, which is then tightened. This detachable snare enables the removal of large polyps and other elevated lesions without bleeding. The loop is made of nylon because the removal of an elevated lesion required high-frequency current. At Sakura National Hospital between May 1989 and October 1990, the detachable snare was used in 11 patients, including 4 with elevated gastric lesions, 2 with elevated duodenal lesions, and 5 with elevated colonic lesions. All of these elevated lesions were pedunculated or semi-pedunculated and measured greater than or equal to 20 mm in maximal diameter. In all cases, the lesions were removed effectively, resulting in a temporary, residual shallow ulcer.

Endoloop-assisted polypectomy for large pedunculated colorectal polyps

“…In earlier studies, bleeding usually occurred immediately after snaring, whereas in more recent reports, delayed hemorrhage accounts for about 65% of postpolypectomy bleeding, and may occur as long as 3 to 4 weeks after polypectomy, although it most often occurs within the first 24 h. This is possibly attributable to the change from blended to coagulation current [12]. New strategies aimed at preventing bleeding after polypectomy include the endoloop technique, first introduced by Pontecorvo and Pesce [13] and developed by Hachisu [14], for endoscopic ligation of the stalk of large pedunculated polyps. Moreover, a significant advantage of using loop ligation for large pedunculated polyps with a thick stalk is the ability to use greater electrosurgical generator power, including cutting or blended current for polypectomy, without fear of precipitating hemorrhage.…”

Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study

“…Submucosal injection in the base of polyps with epinephrine solution (1:10,000) causes vasoconstriction and mechanical compression of the polyp vessels, resulting in reduced blood flow and lower incidence of bleeding episodes [13][14][15]. Detachable snares (endoloop), developed by Hachisu [16], are placed around the stalk either before or after polypectomy to prevent bleeding by stopping blood flow in the stalk [17][18][19]. Hemoclips are used for postpolypectomy hemostasis by either clamping the base before polypectomy [20] or by closing the mucosal defect after polypectomy [21]; although effective in stopping postpolypectomy bleeding, their prophylactic use has been questioned [22].…”

Combination of Adrenaline Injection and Detachable Snare Application as Haemostatic Preventive Measures, Before Polypectomy of Large Colonic Polyps in Children

“…The detachable snare was originally developed by Hachisu [5]. Studies in adults have shown the beneficial effect of either the application of a detachable snare or the injections of adrenaline solutions before the conventional polypectomy [6,7].…”