胃および十二指腸ポリープに対する留置スネアを用いた内視鏡的ポリペクトミーの経験

Abstract

Remarkable developments have been made recently in endoscopic ther- apies, such as endoscopic sphincterotomy, endoscopic injection sclerotherapy and endos- copic hematostatic procedures. Specifically, endoscopic polypectomy has been widely used for the resection of polyps in the digestive tract. As endoscopic polypectomy is employed for the excision of large polyps, the incidence of serious complications such as hemorrhage and perforation has been increasing. Hemorrhage is the most frequent serious complication in endoscopic polypectomy. Therefore, several procedures, such as local injection of hypertonic saline epinephrine, clipping and ligation methods have been devised to prevent the complication. We report here our experience of endoscopic polypectomy againt gastric and duodenal polyps by the use of snare loops. This method is easy to apply. We ligated the bottom of a polyp by a snare loop, and excised with an electrocautery snare. Case 1 had a relatively large-sized hyperplastic polyp, 30 mm in diameter, in the posterior wall of gastric antrum. Endoscopic ultrasonography revealed that the polyp had a vessel at its bottom. Cases 2 and 3 had adenomatous polyps in the duodenum of 10 mm and 70 mm in diameter, respectively. In all the cases, after ligating the bottom of a polyp by a snare loop, endoscopic polypectomy was carried out successfully at the proximal peripheral side with an electric coagulator without any complications. Endoscopic examination one week after the polypectomy revealed that there was a snare loop in case 1, which was removed by biopsy forceps without any bleeding, and that there remained no snare loops in cases 2 and 3. Thus it was demonstrated that ligation by a snare loop is a useful method for preventing hemorrhage in the endoscopic polypectomy of relatively large-sized gatroduodenal polyps.