Yonsei Med J.  2008 Aug;49(4):680-686. 10.3349/ymj.2008.49.4.680.

Needle Knife-assisted Endoscopic Polypectomy for a Large Inflammatory Fibroid Colon Polyp by Making Its Stalk into an Omega Shape Using an Endoloop

• Kim BC
• Cheon JH
• Lee SK
• Kim TI
• Kim H
• Kim WH

• KMID: 1793209
• DOI: http://doi.org/10.3349/ymj.2008.49.4.680

Abstract

Colonic inflammatory fibroid polyp (IFP) is an uncommon benign polypoid lesion, which is composed of fibroblasts, numerous small vessels and edematous connective tissue with marked eosinophilic inflammatory cell infiltration. This condition is frequently detected in the stomach and small intestine, but uncommon in the colon. Although IFP is a benign lesion, surgical resections are performed in most colonic cases because the polyps are usually too large to resect endoscopically. Only three patients underwent endoscopic polypectomy in our literature reviews. Here, we present a case of IFP in the descending colon successful endoscopically resected using a novel technique of trapping its stalk with an endoloop, forming the stalk into an omega shape, and then dissecting the stalk with a needle knife.

Keyword

Inflammatory fibroid polyp; needle knife; endoloop; polypectomy

MeSH Terms

Adult
Colectomy
Colonic Polyps/*pathology/*surgery
Colonoscopy/*methods
Female
Humans
Leiomyoma/pathology/*surgery

Figure

• 

  Fig. 1 Colonoscopic findings demonstrated a 4.5 cm-sized pedunculated polyp (A) with multiple surface erosions, exudates, and nodules on its head and long, thick stalk (B) in the distal descending colon. The polyp occupied nearly the entire colonic lumen.

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  Fig. 2 The polyp was treated by needle knife assisted endoscopic polypectomy because of the difficulty in trapping the large pedunculated shape using an endoloop. For the first step, an endoclip was positioned to partially clamp the stalk (A). Next, hypertonic saline was injected at the base of stalk (B). Dissection of the stalk with a needle knife was attempted, but significant bleeding from the stalk was observed, and consequently dissection was stopped. Next, we tried to trap the polyp with an endoloop, which was not satisfactorily performed due to the large head and rambling mobility of the polyp. Endolooping was finally carried out by tightly seizing the omega shaped stalk (C). We reinserted the scope with a translucent cap, and dissected the stalk of the polyp with a needle knife (D).

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  Fig. 3 The specimen was 4.5 × 2.8 × 3.0 cm in size, had multiple nodules, and an erosive surface with exudates.

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  Fig. 4 Microscopic findings showed mucosal ulceration with the proliferation of stromal cells, onion-skin-like spindle-shaped cells, lymphocytes, many vascular structures, fibrosis and eosinophils, which is consistent with an inflammatory fibroid polyp (hematoxylin and eosin stain).

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  Fig. 5 The illustration of schematic polypectomy procedure in our case. For the first step, the colonoscope approached the stalk of polyp with endoloop slowly expanded (A). Next, we pushed up the stalk with the scope making it crooked and further expanded the endoloop simultaneously (B). Endolooping was finally carried out by tightly seizing the stalk into omega shape (C). The scope with a translucent cap was inserted again, and the proximal portion of stalk was dissected with a needle knife (D).

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