Prophylactic endoscopic double endoloop hemostasis for large pedunculated colorectal polyps with a stalk: a single-center study (with video)

Abstract Background and Aims: This study aimed to explore a novel prophylactic endoscopic therapy for post-polypectomy bleeding of larger colon polyps with a stalk (≥15 mm) and improve clinical outcomes. We also evaluated the feasibility and safety of prophylactic double endoloop hemostasis (PDEH) for larger colon polyps with a stalk (≥15 mm). Methods: This single-center prospective study included 16 patients with larger colon polyps with stalks (≥15 mm) between January 2020 and March 2022. The first endoloop (MAJ-254, MAJ-340; Olympus, Tokyo, Japan) was positioned at the base of the stalk, followed by conventional snare polypectomy. The second endoloop passed through the tail of the first endoloop and slowly approached the base. It was then successfully placed near the first endoloop to decrease the possibility of delayed bleeding. Results: A total of 16 enrolled patients underwent complete endoscopic resection, as confirmed by histopathology (three females, 13 males). The mean age of the patients was 49.8±13.8 years, and 10 patients had polyps in the sigmoid colon (62.5%). The mean diameter of all polyps was 25.6±9.5 mm, and the largest polyp had a diameter of 50 mm. Meanwhile, the mean width of the pedunculated polyps was 7.5±1.3 mm. Only six patients underwent cap-assisted endoscopic polypectomy (46.1%). The mean procedure time was 11.5±2.8 min with or without cap assistance. Additionally, the mean hospital stay was 1.7±0.4 days. Conclusions: PDEHwas found to be a feasible and safe technique for larger pedunculated colon polyps.