Clin Endosc.  2016 Jul;49(4):350-354. 10.5946/ce.2016.059.

Endoscopic Instruments and Electrosurgical Unit for Colonoscopic Polypectomy

• Park HJ

• KMID: 2348253
• DOI: http://doi.org/10.5946/ce.2016.059

Abstract

Colorectal polypectomy is an effective method for prevention of colorectal cancer. Many endoscopic instruments have been used for colorectal polypectomy, such as snares, forceps, endoscopic clips, a Coagrasper, retrieval net, injector, and electrosurgery generator unit (ESU). Understanding the characteristics of endoscopic instruments and their proper use according to morphology and size of the colorectal polyp will enable endoscopists to perform effective polypectomy. I reviewed the characteristics of endoscopic instruments for colorectal polypectomy and their appropriate use, as well as the basic principles and settings of the ESU.

Keyword

Colonoscopic polypectomy; Snare; Surgical instruments; Instrumentation; Electrosurgical generation unit

MeSH Terms

Colorectal Neoplasms
Electrosurgery
Methods
Polyps
SNARE Proteins
Surgical Instruments
SNARE Proteins

Figure

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  Fig. 1. The forceps size (the distance between cups) ranges from 5 to 8 mm (left). The diameter of the cup is about 3 mm (right).

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  Fig. 2. Forceps polypectomy: colorectal polyp ≤3 mm can be removed by one-bite forceps (left), but 4 to 5 mm polyps need two bites for complete resection.

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  Fig. 3. Various shaped snares (upper) and various sizes (lower).

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  Fig. 4. Specific types of snare. (A) Oval snare with spikes. (B) Spiral oval snare. (C) Snareinflator. (D) Rotatable snare.

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  Fig. 5. Variables in endocut mode: coagulation power, cut duration, and interval between previous and next cut.

Reference

1. Baxter NN, Goldwasser MA, Paszat LF, Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death from colorectal cancer. Ann Intern Med. 2009; 150:1–8.

2. Ransohoff DF. How much does colonoscopy reduce colon cancer mortality? Ann Intern Med. 2009; 150:50–52.

3. Fyock CJ, Draganov PV. Colonoscopic polypectomy and associated techniques. World J Gastroenterol. 2010; 16:3630–3637.

4. Kim SE, Hong SP, Kim HS, et al. A Korean national survey for colorectal cancer screening and polyp diagnosis methods using web-based survey. Korean J Gastroenterol. 2012; 60:26–35.

5. Lee CK, Shim JJ, Jang JY. Cold snare polypectomy vs. cold forceps polypectomy using double-biopsy technique for removal of diminutive colorectal polyps: a prospective randomized study. Am J Gastroenterol. 2013; 108:1593–1600.

6. Monkemuller KE, Fry LC, Jones BH, Wells C, Mikolaenko I, Eloubeidi M. Histological quality of polyps resected using the cold versus hot biopsy technique. Endoscopy. 2004; 36:432–436.

7. Lee SH, Shin SJ, Park DI, et al. Korean guideline for colonoscopic polypectomy. Clin Endosc. 2012; 45:11–24.

8. Tsai FC, Strum WB. Prevalence of advanced adenomas in small and diminutive colon polyps using direct measurement of size. Dig Dis Sci. 2011; 56:2384–2388.

9. Yamano H, Matsushita H, Yamanaka K, et al. A study of physical Efficacy of different snares for endoscopic mucosal resection. Dig Endosc. 2004; 16(Suppl 1):S85–S88.

10. Iishi H, Tatsuta M, Narahara H, Iseki K, Sakai N. Endoscopic resection of large pedunculated colorectal polyps using a detachable snare. Gastrointest Endosc. 1996; 44:594–597.

11. Miller K, Waye JD. Polyp retrieval after colonoscopic polypectomy: use of the Roth Retrieval Net. Gastrointest Endosc. 2001; 54:505–507.

12. Barlow DE. Endoscopic applications of electrosurgery: a review of basic principles. Gastrointest Endosc. 1982; 28:73–76.

13. Boulay BR, Carr-Locke DL. Current affairs: electrosurgery in the endoscopy suite. Gastrointest Endosc. 2010; 72:1044–1046.

14. Van Gossum A, Cozzoli A, Adler M, Taton G, Cremer M. Colonoscopic snare polypectomy: analysis of 1485 resections comparing two types of current. Gastrointest Endosc. 1992; 38:472–475.

15. Morris ML, Tucker RD, Baron TH, Song LM. Electrosurgery in gastrointestinal endoscopy: principles to practice. Am J Gastroenterol. 2009; 104:1563–1574.

16. Singh N, Harrison M, Rex DK. A survey of colonoscopic polypectomy practices among clinical gastroenterologists. Gastrointest Endosc. 2004; 60:414–418.

17. Fry LC, Lazenby AJ, Mikolaenko I, Barranco B, Rickes S, Mönkemüller K. Diagnostic quality of: polyps resected by snare polypectomy: does the type of electrosurgical current used matter? Am J Gastroenterol. 2006; 101:2123–2127.