{"doi":"10.1016/j.vgie.2020.06.008","title":"Detachable snare to prevent postpolypectomy bleeding","abstract":"Pedunculated polyps with a thick stalk (>5 mm) have an increased risk of bleeding with resection.1Dobrowolski S. Dobosz M. Babicki A. et al.Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy.Gastrointest Endosc. 2006; 63: 1004-1009Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Bleeding risk can be reduced by placing a detachable snare around the stalk of the polyp before resection.2Brandimarte G. Tursi A. Endoscopic snare excision of large pedunculated colorectal polyps: a new, safe, and effective technique.Endoscopy. 2001; 33: 854-857Crossref PubMed Scopus (34) Google Scholar, 3Hachisu T. A new detachable snare for hemostasis in the removal of large polyps or other elevated lesions.Surg Endosc. 1991; 5: 70-74Crossref PubMed Scopus (90) Google Scholar, 4Iishi H. Tatsuta M. Narahara H. et al.Endoscopic resection of large pedunculated colorectal polyps using a detachable snare.Gastrointest Endosc. 1996; 44: 594-597Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar, 5Kouklakis G. Mpoumponaris A. Gatopoulou A. et al.Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study.Surg Endosc. 2009; 23: 2732-2737Crossref PubMed Scopus (83) Google Scholar In this video (Video 1, available online at www.VideoGIE.org), we demonstrate step-by-step use of a detachable snare for resection of a large pedunculated gastric polyp. The indications for use of a detachable snare include prevention or treatment of postpolypectomy bleeding, particularly of pedunculated polyps with a thick stalk or gastric polyps. The equipment used in this technique is the ENDOLOOP Ligature (Ethicon, Somerville, NJ, USA). The patient was a 39-year-old woman who presented with epigastric pain. Upper endoscopy found a large pedunculated polyp in the gastric antrum (Fig. 1). Resection of the largest polyp was planned. To reduce the bleeding risk, we planned to place a detachable snare around the stalk of the polyp (Video 1, available online at www.VideoGIE.org). First, we demonstrate how to bring the loop inside and outside the sheath. To advance the detachable snare, the yellow slide should be pulled toward the handle (Fig. 2). To withdraw the snare back into the sheath, the yellow slide should be pushed away from the handle (Fig. 3).Figure 3Withdraw the snare back into the sheath by pushing the yellow slide away from the handle.View Large Image Figure ViewerDownload Hi-res image Download (PPT) With the detachable snare withdrawn into the sheath, feed the sheath into the accessory channel. Advance the detachable snare by pulling the yellow slide toward the handle. Carefully maneuver the detachable snare over the polyp (Fig. 4). This can be challenging, given the size of the detachable snare in relation to the polyp. In this circumstance, the snare can be retracted into the sheath and gradually advanced to aid in maneuverability. Ensure the snare is around the entire polyp. If unsure, withdraw the snare into the sheath to mimic closing the snare. Carefully inspect the base to ensure the polyp is fully captured. Once this is confirmed, preparations to deploy the snare can be made. Tighten the detachable snare by closing the handle until resistance is met (Fig. 5). Check for blanching of the polyp. Before deployment, the metallic release must be visible endoscopically, and the yellow slide must be flush with the base of the handle (Figs. 6 and 7). Deploy the detachable snare by fully opening the handle (Fig. 7). Remember that this should only occur once the yellow slide is flush with the base of the handle and the metallic release is visible endoscopically; if otherwise, the detachable snare may not release and could become trapped in the sheath.Figure 7Deploy the detachable snare by fully opening the handle. Note that the yellow slide is flush with the base of the hand","journal":"VideoGIE","year":2020,"id":114053,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9439,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":536876,"name":"Amin Soltani","orcid":"0000-0003-0687-7404","position":1,"is_corresponding":false},{"id":536877,"name":"Kumar Krishnan","orcid":"0000-0002-9962-8732","position":2,"is_corresponding":false},{"id":393295,"name":"Jacqueline N. 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