Endoscopic resection using the Clutch Cutter and a detachable snare for large pedunculated colonic polyps

Abstract

Endoscopic snare polypectomy with prophylactic detachable snare of large pedunculated colonic polyps (PCPs) is technically demanding. To facilitate removal of such polyps, we developed endoscopic resection using the Clutch Cutter and a detachable snare (ERCCDS). This study aimed to evaluate the efficacy and safety of the procedure. From April 2010 to July 2015, 14 consecutive patients who had PCPs with head> 10 mm, stalk width > 5 mm, and stalk length > 10 mm were enrolled in this single-center prospective uncontrolled study. They were treated using ERCCDS by a single endoscopist. The efficacy and safety were assessed using a database prospectively formatted from the medical records. The Clutch Cutter was able to cut the distal side of the stalk an adequate distance from the detachable snare under good visual control. R0 resections were obtained in all lesions. There were no immediate or delayed complications. ERCCDS appears to be a safe, easy, and technically efficient method for large PCPs, although larger studies are needed to compare ERCCDS and standard resection.

Advances in endoscopic therapy using grasping-type scissors forceps (with video)

“…When an endoscopist performs polypectomy for a large pedunculated polyp, the snare on the back side of the thick stalk cannot be seen, and it is difficult to check for adequate positioning of the distal side of the snare using an endoscopic view and to determine whether the distal part of the snare is on the stalk of the polyp or on the normal mucosa on the distal side. No visibility of the distal part of the snare during the procedure leads to piecemeal polypectomy or severe adverse events, such as perforation and bleeding[ 29 , 30 ]. If the CC is used to remove a large pedunculated polyp, the large stalk is also grasped and pulled by the CC and cut little by little, so that the distal side of the stalk can be accurately incised under good endoscopic view[ 30 - 32 ].…”

“…No visibility of the distal part of the snare during the procedure leads to piecemeal polypectomy or severe adverse events, such as perforation and bleeding[ 29 , 30 ]. If the CC is used to remove a large pedunculated polyp, the large stalk is also grasped and pulled by the CC and cut little by little, so that the distal side of the stalk can be accurately incised under good endoscopic view[ 30 - 32 ]. Like the snare, the CC is energized while grasping and compressing; therefore, it provides strong hemostasis, less intraoperative bleeding, and even if there is bleeding, this can be stopped immediately by the CC.…”

“…When this occurs, cutting the stalk using an electrosurgical current and releasing the snare are both impossible. However, if the CC is used, releasing the blades by opening the CC is easy [ 30 ]. Previous reports of polypectomy using the CC for large pedunculated polyps indicated 100% R0 resection without complications[ 30 - 32 ].…”

“…However, if the CC is used, releasing the blades by opening the CC is easy [ 30 ]. Previous reports of polypectomy using the CC for large pedunculated polyps indicated 100% R0 resection without complications[ 30 - 32 ]. This appears to be a promising future indication for the CC (Figure 7 and ).…”

Scissor-type needle-knife for colorectal endoscopic submucosal dissection

“…Another example of a scissor-type knife is the ClutchCutter (Fujifilm Medical, Tokyo, Japan). Data reported on the utility of different types of electrocautery knife for colorectal ESD have been limited to small single-center case series [4,5].…”