Endoscopic retrieval method using a small grip-seal plastic bag for large colorectal resection specimens after endoscopic submucosal dissection.

has recently been developed for endoscopic treatment of colorectal polyps, enabling en bloc resection regardless of size and shape [1,2]. However, it is often difficult to retrieve a large resected colorectal specimen after ESD without damage to the specimen by the anal sphincter muscle. Here, we report an effective technique to retrieve a large colorectal resected specimen after ESD without damage. The polyp in this case was located in the rectum: a laterally spreading tumor, granular type, approximately 4 cm in diameter. En bloc resection of the polypwas successfully performed using the FlushKnife BT (Fujifilm, Tokyo, Japan). After the resection we reinserted the scope, which was covered with a small grip-seal plastic bag (14 × 8.5 cm) (●" Fig. 1a). To expand the entrance of the bag, the top was grasped by an alligator forceps inserted alongside the scope (●" Fig. 2a). The scopewaswithdrawn to free it from the plastic bag (●" Fig. 2b). Next, another alligator forceps was inserted through the scope and the resected specimen was placed into the plastic bag using the second forceps (●" Fig. 2c). The plastic bag was then grasped by both sets of forceps and pulled out. The resected specimen was retrieved without damage by the anal sphincter muscle (●" Figs. 1b, 2d). Our technique is safe and easy, requires no special devices, and could be employed not only in the colorectum but also potentially in the upper gastrointestinal tract. To our knowledge, there are reports of retrieval methods using a bag in laparoscopic surgery [3,4], but this is first report of an endoscopic retrieval method using a small grip-seal plastic bag for a large colorectal polyp after ESD. We have successfully used this method 10 times at the Kobe University gastroenterology unit. We feel that this technique is cheap and effective for retrieving large polyps after ESD without specimen damage.