Difficult colon polypectomy

Table 3 Accessories and utensils used in advanced polypectomy

Hot biopsy forceps (we do not recommend to use hot biopsy forceps for colon polyp removal)

Single use

Resusable

Monofilament and braided wire snares of various diameters, e.g. mini < 11 mm, standard 15-45 mm)

Mini oval (recommended to remove diminutive polyps using the cold-snare technique, i.e. without heat of electrosurgical current)

Standard oval

Hexagonal

Crescent

Spiral

Mini barbed (the multiple barbs (help hold the tissue inside of the snare)

Needle-tip anchored (the needle tip on top the distal part of the snare helps stabilize the position of the snare, however the tip can lacerate the healthy mucosa)

With heat- resistant net (Nakao net) (not widely available)

Injection needle(s)

Injection substances (normal saline, hypertonic saline, dextrose 50%, adrenaline, sodium hyaluronidate

India ink (used for tattooing and marking)

Dyes (methylene blue, indigo carmine)

Combination needle/snare (allows for injection-assisted polypectomy and immediate snaring)

Rotatable snares (may be useful for polyps located in difficult luminal location, when the scope cannot be torqued to an ideal position)

Endoscopic fitted caps (allow the detection of polyp behind folds)

Without snare rim

With snare rim

Needle knifes (at least 20 different types available for endoscopic submucosal dissection)

Without insulated tip

With insulated tip

Flush-knife

Clips (hemoclips or endoclips) (single use or reusable)

Endoloops

Retrieval devices

Baskets

Nets (Roth net)

Grasping forceps with two to five prongs