Colored Ring-Shaped Thread Tag Clippings to Identify the Accurate Location of Multiple Polyps Resected via Endoscopic Mucosal Resection

Collection of multiple resected proximal colon polyps >10 mm in size through a scope channel via aspiration following an endoscopic mucosal resection (EMR) is difficult; thus, polyps are currently all grasped at once using net forceps. However, the simultaneous collection by net forceps makes it difficult to identify the accurate locations of all resected polyps. Therefore, we aimed to investigate a novel technique to identify the accurate location of resected polyps using colored ring-threads. A 58-year-old man was diagnosed with three ascending colon polyps approximately 10-mm in diameter. These polyps were located in the proximal colon and had the potential for cancerous components. The polyps were found to have an irregular microvascular pattern via narrow-band imaging magnified endoscopy. Thus, confirmation of the accurate location of each polyp was necessary because of the possibilities of subsequent additional EMR and surgery. Therefore, slight tattooing was performed in close proximity to each polyp. We prepared three types of colored and six sized ring-threads, such as white, purple, and black. After the local injection was performed and sufficient bulging was obtained, a white ring-thread 5-mm in diameter was clipped through the scope channel and fixed close to the first polyp. EMR was performed and included the clip