Combined biopsy forceps and scissor forceps facilitate cutting the detachable loop entrapped in a large pedunculated polyp.

A 58-year-old man was referred for resection of a pedunculated polyp, which had a head measuring 3.5×2.8cm and a stalk 1.5cm in diameter, over the sigmoid colon. We initially applied a detachable loop over the stalk, but no total cyanotic change of the polyp head was observed. We applied a second loop, but it became entrapped in the head of the polyp without tightening (●" Fig.1). We attempted to cut the redundant loop using singlescissor forceps (FS-3L-1; Olympus, Tokyo, Japan) (●" Fig.2), but failed because the nylon loop easily slipped away from the flat blades. Therefore, we used a doublechannel gastroscope (GIF-2TQ260M; Olympus) and combined biopsy forceps to grasp the loop and scissor forceps to cut the loop and remove it successfully (●" Fig.3 and●" Video 1). After ensuring effective ligation of the stalk using an additional third loop, we finally resected the polyp by cutting the stalk with a DualKnife (KD-650 U; Olympus) and smoothly dragged the polyp out (●" Fig.4). Histological examination confirmed the polyp to be a tubulovillous adenoma with focal adenocarcinoma confined to the mucosal layer. A detachable loopmight occasionally stick to the ligating device, and recommendations are available for that situation [1]. In addition, events that are more common involve the ineffective loop being entrapped in the polyp and being difficult to remove with forceps only, especially when there is a large pedunculated polyp in a limited space. Using scissor forceps is another choice – either using two flat blades for cutting tissue or foreign objects within the digestive tract, or using a depressed portion of one of the blades, a so-called loop cutter. The grasping and cutting method using a double-channel scope facilitates cutting the loop using flat-blade scissor forceps. Based on our research, no such combinatory technique has been reported in relevant literature.