Endoscopic Combined Snare-Forceps Technique for Removing Flat Sessile Polyps

CONTEXT: Current endoscopes have limitations during use in polypectomies. Specifically, polyps that are flat, broad-based and sessile are more difficult to resect. Routine polypectomy procedures allow one endoscopic device to be used at a time limiting the endoscopist. More advanced scopes are not readily available at smaller community hospitals, limiting the endoscopist to using the resources available to them. METHODS: The modification of the standard polypectomy method described here employs both an endoscopic forceps and an endoscopic snare to be used simultaneously during colonoscopy with a single lumen colonoscope. The forceps is introduced into the endoscope so the head is just projecting from the distal end of the scope. The snare is then placed just proximal to the head of the forceps outside of the endoscope. The endoscope is reinserted into the colon until the polyp is reached. Using the snare the polyp is elevated and then the snare secured around the base. RESULTS: This resulted in easier, faster, and more complete removal of flat sessile and poorly located pedunculated polyps on the first try. This technique has been employed successfully in over 20 patients at our institution. CONCLUSIONS: This new method adds another technique for endoscopists when presented with difficult polypectomies.