Endoscopic ligation by means of clip and detachable snare for management of colonic postpolypectomy hemorrhage

Postpolypectomy hemorrhage, the most common complication of polypectomy, can be classified as immediate or delayed bleeding. Immediate bleeding can be controlled with various endoscopic methods (regrasping the stalk, epinephrine injection, coagulation with hot biopsy forceps or heater probe, rubber band ligation).1 Delayed bleeding seems to be more common.2,3 Most delayed hemorrhaging stops spontaneously and can be managed with conservative therapy. However, delayed arterial bleeding may necessitate transfusion, angiography, or surgical intervention. Injection of the stalk with epinephrine or sclerosants before transection is recommended to diminish risk for postpolypectomy hemorrhage. Epinephrine injection, however, may prevent only immediate bleeding, and use of sclerosants may increase risk for perforation.4 A detachable snare5-7 has been developed for the prevention of postpolypectomy hemorrhage. We performed endoscopic placement of a detachable snare to ligate a site of postpolypectomy arterial bleeding in the sigmoid colon.