Bipolar Snare Polypectomy – A Safer Technique for Electrocoagulation of Large Polyp Stalks

Abstract

Conventional colonoscopic snare polypectomy for large polyps with stalk diameter of 1.5 cm or more carries a significant risk of haemorrhage after transection, probably due to "leak currents". The use of a return-electrode applied to the base of the polyp after snaring instead of the conventional patient-plate permits bi-polar polypectomy which is both safer and more efficient.

Evaluation of complications related to therapeutic colonoscopy using the bipolar snare

“…This device theoretically minimizes the depth of the burn and thus the degree of tissue destruction. Williams and de Peyer [16] were the first to report use of the bipolar snare for safer endoscopic resection. However, because this technique was complicated and required a two-channel scope, it was not widely used thereafter.…”

“…Among the devices used for removal, the bipolar snare is an option. Use of the bipolar snare as a safer technique for polypectomy was first reported by Williams and de Peyer [16] in 1979. Tucker et al [17] evaluated the energy required and the tissue damage created by the monopolar and bipolar snares in a canine model.…”

Total colonoscopy in children

“…Snare polypectomy was performed in 8 patients (13 polyps, of which 5 were at least 2 cm in diameter). 25 The polypectomies in our series were considered technically easy for an endoscopist with experience of more than 1000 adult polypectomies, since the majority of the polyps were juvenile with characteristically thin stalks.…”

Safety of endoscopic procedures with monopolar versus bipolar instruments in an ex vivo porcine model

“…One way to reduce complications during therapeutic endoscopy is the use of a bipolar instrument. This device theoretically minimizes the depth of burning and degree of tissue destruction [21,22]. Saraya et al reported an incidence of perforation as low as 0.08% for endoscopic resection with a bipolar snare.…”