Matsushita M, Hajiro K, Takakuwa H, Kusumi F, Maruo T, Ohana M, Tominaga M, Okano A, Yunoki Y
Department of Gastroenterology, Tenri Hospital, Nara, Japan.
Gastrointest Endosc. 1998 Jun;47(6):496-9. doi: 10.1016/s0016-5107(98)70251-2.
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.
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.
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.
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.
大肠镜下大息肉切除术可能会引发诸如出血等并发症。使用可分离圈套器或许能降低出血风险。我们描述了几例使用该器械却被证明无效的情况。
对18例患者（20枚息肉）使用可分离圈套器进行大肠镜下大息肉切除术，另外对5例患者（5枚息肉）在常规息肉切除术后对残留蒂部使用该圈套器，并进行回顾性评估。
20枚息肉中16枚有蒂，4枚为半有蒂。在4枚半有蒂病变中，有3枚在息肉切除术后圈套器滑脱，原因是病变在靠近圈套部位处被切断。4例发生出血，原因分别是在息肉切除术前细蒂（4毫米）被圈套器切断（1例）、半有蒂病变中圈套器滑脱（1例）或圈套器收紧不足（2例）。在常规息肉切除术后，5枚病变中有3枚因残留蒂部变平而无法有效地用圈套器套住。
对细蒂或半有蒂病变进行息肉切除时使用可分离圈套器可能导致该技术操作失败。在息肉切除术前，圈套器应完全环绕蒂部。在常规息肉切除术后，可分离圈套器难以应用于残留蒂部。
