ASGE Masterclass: Expert Performance Approach to Colonoscopy (On-Demand) | February 2026-Resection of Pendunculated Colorectal Lesions

Video Transcription

Video Summary

The speaker reviews management of large pedunculated colon polyps, which have higher bleeding risk when the head is large and the stalk is thick. Prophylactic options include endoloop placement, clipping, or epinephrine injection. Technical tips focus on making the polyp “stand up” by recognizing it is usually hanging and adjusting scope rotation (and sometimes patient position) to align the stalk with the working channel; water immersion can help create space to slip a loop or snare around a large head.<br /><br />For endoloops, success depends on using the sheath to position the loop at the stalk base and closing in a coordinated way (open sheath slightly while tightening) to prevent curling, then waiting for visible ischemia before cutting. When cutting, the snare should be very tight and placed so cautery burns at the snare, not near the loop.<br /><br />A debate follows: in suspected cancer, endoloops may force a higher cut and risk positive margins; alternatives include low stalk resection with post-cut clipping, emphasizing oncologic outcomes and minimizing thermal injury near clips. Epinephrine can shrink clearly benign polyps; clip-and-cut is cautioned. Lipomas may be ligated and left to slough off.

Keywords

large pedunculated colon polyps

prophylactic hemostasis (endoloop, clips, epinephrine)

post-polypectomy bleeding risk

endoloop technique and ischemia confirmation

snare polypectomy cautery placement

oncologic margins in suspected malignant polyps