7085 Preventive clipping following bipolar snare removal of pedunculated colonic polyps.

PURPOSE : Bipolar snares minimize tissue damage, but are not used generally for colonic polypectomy in Japan, probably because increased risk of bleeding reflecting insufficient coagulation is suspected. Since clipping has been reported to be useful in preventing bleeding after monopolar snare polypectomy, we sought to determine whether clipping can prevent bleeding in removal of pedunculated polyps using the bipolar snare. METHODS: We studied patients whose colonic lesions were pedunculated polyps=5 mm in diameter and endoscopically appeared confined to the mucosal layer.We performed bipolar snare polypectomy and added preventive clipping to clamp the stump immediately after polypectomy even when no bleeding was encountered.We assessed retrospectively the histologic diagnosis of the resected specimen, the completeness of polypectomy, and the occurrence of bleeding and perforation. RESULTS : Between April 1997 and March 1999, we evaluated 11 lesions in 10 patients. 11 pedunculated polyps (diameter of head, 10.0 ± 4.1 mm) were resected completely. Histologically, 10 lesions were purely adenoma while 1 contained focal admocarcinoma that arose in the adenoma but was confined to the mucosa. Technical success with clipping was achieved in all cases. No postpolypectomy bleeding, perforation, or complications from dipping occurred. CONCLUSIONS :We found clipping to be effective in preventing bleeding after bipolar snare removal of pedunculated colonic polyps. A bipolar snare which has the advantage of shallow tissue damage can be employed safely by using preventive clipping.