Safe endoscopic resection of a giant pedunculated colonic polyp after epinephrine volume reduction with clip placement

Q3 Medicine

VideoGIE Pub Date : 2026-05-01 Epub Date: 2025-12-26 DOI:10.1016/j.vgie.2025.12.001

Tsukasa Ishida MD, PhD, Hiroyuki Hashimoto MD, Akiko Shioya MD, Masaru Takimoto MD, Yusuke Nakata MD, Taro Tanaka MD, Yukako Masuko MD, Takashi Nakashima MD, PhD

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引用次数: 0

Abstract

Background and Aims

Resection of giant pedunculated colorectal polyps can be challenging because of adverse events such as bleeding and technical difficulties in snaring. Epinephrine injection may reduce tumor size, but its efficacy for giant lesions is limited.

Methods

A 59-year-old woman presented with a 50-mm pedunculated polyp in the transverse colon. A total of 20 mL of diluted epinephrine (1:10,000) was injected into the apex and stalk of the polyp, and 6 hemostatic clips were placed near the stalk base. Three weeks later, a follow-up colonoscopy was performed.

Results

After a 3-week interval, the polyp exhibited marked shrinkage. En bloc resection was achieved using underwater EMR with a 25-mm snare. Histology revealed a tubulovillous adenoma with negative margins. The patient was discharged without any adverse events.

Conclusions

A 5-cm pedunculated colorectal polyp was successfully managed by endoscopic resection 3 weeks after epinephrine volume reduction and clip placement. This method may offer a useful option when immediate resection is not feasible.

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肾上腺素减容夹置入后安全内镜切除巨大带蒂结肠息肉

背景与目的由于出血等不良事件和诱捕技术上的困难，切除巨大的带蒂结直肠息肉是具有挑战性的。肾上腺素注射可减小肿瘤大小，但对巨大病变的疗效有限。方法一名59岁女性患者在横结肠发现一50毫米带蒂息肉。将稀释后的肾上腺素按1:10 000的比例共20 mL注射到息肉的尖端和茎部，并在茎基部附近放置6个止血夹。三周后，再次进行结肠镜检查。结果3周后，息肉明显缩小。使用带有25毫米陷阱的水下EMR实现了整体切除。组织学显示为管状绒毛状腺瘤，边缘呈阴性。患者出院，无任何不良事件。结论经肾上腺素减容和夹夹放置3周后，内镜下切除5 cm带蒂结肠息肉成功。当不能立即切除时，这种方法可能是一个有用的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.