{
  "abstract": "Introduction Due to large feeding vessels in the stalk of pedunculated colonic polyps, there is a risk of immediate and delayed post polypectomy bleeding using snare diathermy. The use of a coagulation current cauterises the vessel but this may increase the risk of delayed bleeding and also create more extensive diathermy artefact hindering pathological assessment of the polyp. Conversely, using a pure cut current may reduce diathermy injury but may increase the risk of bleeding. The Endoloop is a nylon detachable snare which can be used to reduce the risk of post polypectomy bleeding for large pedunculated polyps. We show that the use of minimal coagulation current is safe and effective when used following Endoloop placement.Methods We collected data for all Endoloop assisted resections of Paris 0-Ip colonic polyps at our centre. All procedures were carried out using the Olympus PolyLoop Ligation Device which was placed as close to the base of the polyp stalk as possible. The polyps were resected using a variety of snares placed 2 mm above the Polyloop using the ERBE 200D or VIO3 Electrosurgical Unit. Diathermy settings were set to EndoCut Q, Effect 1, Cut Duration 2, Cut Interval 6. Effect 1 has no coagulation current in between cutting cycles and a rapid snare closure technique was used for all polyps to minimise cautery damage to tissue.Results We included 118 Endoloop assisted polypectomies in 114 patients between June 2010 and January 2025 (65.2% male, mean age was 63.8 years (29 to 85 years)). 96.6% of polyps were distal to the splenic flexure. Pathology results were unavailable for 1 case. Mean maximal dimension of the pathology specimen was 19.5 mm (7 to 35 mm). 5/117 (4.3%) polyps showed invasive adenocarcinoma (all R0 resections, 3 cases Haggit 1, 2 cases Haggit 3). 16/117 (13.7%) were adenomas with HGD and 83/117 (70.9%) were adenomas with LGD. 1 polyp showed marginal zone lymphoma and 3 hyperplastic polyps. 107/117 (91.5%) polyps were confirmed to be completely excised on pathology but in 5/117 (4.3%) this was not specified. Site checks were negative in all cases where this was carried out.3 patients had immediate minor bleeding which was managed with clips, 1 loop slipped immediately post deployment and 1 loop interfered with snare placement and the polyp had to be resected piecemeal. 1/118 (0.85%) patient had a delayed bleed 10 days later requiring observation only (AGREE Grade 1 - modified Clavien Dindo). This patient was not on antithrombotics. 4 patients were on warfarin, 11 on DOACs and 7 on P2Y12 inhibitors.Conclusions This is one of the largest case series available for Endoloop assisted colonic polypectomy. Minimising the use of coagulation current for snare diathermy, we demonstrate effective polypectomy with high histologically confirmed complete excision rates and very low immediate/delayed complications when an Endoloop is placed at the base of the stalk of pedunculated colonic polyps prior to resection.",
  "authors": [
    {
      "affiliations": [
        "Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, United Kingdom"
      ],
      "name": "Neeraj Prasad"
    },
    {
      "affiliations": [
        "Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, United Kingdom"
      ],
      "name": "Caitlin Ryder"
    }
  ],
  "title": "P341 Minimal coagulation current diathermy is safe and effective for endoloop assisted resection of large pedunculated colonic polyps",
  "uid": "1f579925-ab41-503e-a3ab-8e7a29c703de"
}