Endoscopic resection of a large pedunculated duodenal polyp using a grasping type scissors forceps.

tally discovered during screening esopha− gogastroduodenoscopy in a 72−year−old woman. The polyp, located in the second portion of the duodenum, had a long stalk and a large head. Its removal was consid− ered to be technically demanding be− cause the head of the polyp occluded the lumen of the duodenum, making it diffi− cult to maneuver the snare over the polyp. The stalk part of the polyp, how− ever, was fully visible, and we tried endo− scopic resection using a newly developed grasping type scissors forceps (GSF) (XDP2618DT; Fujinon) (l" Fig. 1 and l" 2) [1], after obtaining written informed con− sent from the patient. A two channel endoscope was used. First, we applied three long clips (HX−600± 090L; Olympus) to the base of the stalk close to the duodenal wall for the preven− tion of polypectomy−associated bleeding. Second, the upper part of the stalk was held with the grasping forceps to avoid losing the polyp in the distal duodenum. Third, the polyp stalk was resected about 5 mm above the clip by GSF using auto cut mode 120W (l" Fig. 3). No hemor− rhage, perforation, or other complication occurred. Histological diagnosis was a Peutz−Jeghers type polyp. Large pedunculated gastrointestinal tract polyps are often difficult to remove by en− doscopic polypectomy with the standard snare technique [2± 4]. Our approach was to perform endoscopic resection with a GSF [1]. The GSF has a thin serrated cutting edge to facilitate grasping the tis− sue. The outer side of the forceps is insu− lated so that electrosurgical current ener− gy is concentrated at the blade to avoid burning the surrounding tissue. By using the GSF, it was safe and easy to resect the stalk of the polyp. We believe this tech− nique has the potential to become the method of choice for the removal of ped− unculated gastrointestinal tract polyps when other procedures involving snaring of the polyp head are not feasible.