A novel approach to the management of polypectomy snare entrapment: the zip-line technique.

Polypectomy-snare entrapment is a rare but serious complication of colonoscopy, frequently requiring surgical intervention. We report a case of polypectomysnare entrapment successfully treated using a novel endoscopic “zip-line” approach that, to our knowledge, has not been previously reported. A 35-year-old woman underwent a colonoscopy in our office-endoscopy suite, during which a 4 cm, broad-based, semipedunculated polyp was noted in the ascending colon (●" Fig.1). After submucosal epinephrine injection into the polyp base, a 25-mm snare was closed around the polyp and current (coagulation and then blended) was applied; however, the polyp could not be transected. The snare appeared to have become embedded in the polyp tissue and could not be opened. The handle of the snare was now cut and, through an “exchange” technique, the colonoscope was withdrawn, leaving the wire of the entrapped snare exiting the anus. A new snare was then inserted through the colonoscope channel and the entrapped-snare wire was inserted through the open snare (●" Fig.2a), which was then partially closed and withdrawn into the colonoscope, leaving a small portion of the snare outside of the channel. The colonoscope, which at this point appeared to be “hanging” from the entrapped wire as if it were on a “zip line” (●" Fig.2b), was reinserted and easily passed to the level of the polyp (●" Fig.3a). Fig.1 Endoscopic view showing a 4-cm sessile polyp in the ascending colon.