Journal of Gastrointestinal & Digestive System
Open Access

A 64 years old man underwent colonoscopy because a positive fecal occult blood test in screening program.

We performed complete unsedated colonoscopy using water exchange technique in our endoscopy room. In the descending colon we found five sessile polyps of 5-6 mm of diameter resected with cold snare (iperplastic at histology esamination) and in the sigmoid colon a sessile lesion of 10 mm of diameter resected with hot snare after submucosal injection (serrated with low grade of dysplasia at histology) [1,2].

In the distant sigmoid colon was noted a sessile lesion of 60 × 40 mm. After generous submucosal epinephrine injection into polyp base, with homogeneous lifting, a 25 mm standard polyfilament duckbill snare was closed around part of polyp and current (EndoCut Q, effect 4, length and interval 1; forced coagulation 25 W, effect 2 with elettrosurgical unit ERBE VIO 300D) was applied. Lesion could not be performed: the snare become embledded in the polyp tissue and could not be removed. Lesion began to bleed plenty. The handle of the snare was cut and colonoscopy was withdrawal leaving the wire of snare exiting the anus [3,4].

The “zip-line technique” described by Herman et al. [5] was impracticable for size of lesion and profuse bleeding. In addition the patient complained of intense discomfort and abdominal pain for previous polyps resections. So, we preferred to try potentially faster and conservative therapy. At successive colonoscopy we found a snare entrapped in an active bleeding polyp.

Retrieval forcep alligator-tooth type was inserted through the new colonoscopy channel and the entrapped snare was slowly and circumferentially mobilized and then complete removed.

Finally, hemostasis was performed with Hemospray [6]. An abdominal computed tomography revealed lesion suggestive for tumor, then histopathological examination of the specimen confirmed the diagnosis of adenocarcinoma. The patient was referred for surgical treatment.

Snare entrapment during polypectomy is a very rare complication. We report a simple and conservative technique for removed snare in a difficult case of massive bleeding of malignant colon polyp. Hemospray may offer a simple and effective therapy also in acute lower gastrointestinal neoplastic bleeding. Randomized controlled trials are needed to further validate our observation.