Dual-modality Approach To Active Post-polypectomy Bleeding Control

Dual-modality approach to active post-polypectomy bleeding control: single-device hemostasis using snare-tip soft coagulation with saline-immersion.

The Clinical Challenge.

Post-polypectomy bleeding (PPB) remains the most common adverse event following endoscopic mucosal resection (EMR), with incidence ranging from 1–6% for standard polyps and up to 10–15% for large lesions (>20 mm). While delayed bleeding (24 hours–30 days) has been extensively studied, immediate intra-procedural bleeding presents a distinct challenge: the endoscopist must achieve rapid hemostasis while preserving visibility and minimizing the risk of deep thermal injury particularly in the thin-walled right colon.

Traditional approaches include mechanical clips, injection therapy, and thermal coagulation.

Each has limitations:

Clips: May obscure the field, fall off, or be impractical for diffuseoozingInjection: Temporary effect, may impair subsequent coagulation

Standard thermal coagulation: Risk of deep injury, carbonization, and perforation

Device exchanges: Time-consuming, costly, and technically cumbersome during active bleeding

A dual-modality, single-device protocol refined in my practice that addresses all these limitations using one tool already in hand: the polypectomy snare.

The Core Advantage: One Device, Two Techniques.

The fundamental innovation of this approach is hemostasis without device exchange. The polypectomy snare already deployed for resection - becomes a multi-functional instrument:

Why this matters?

⏱️ No time lost to device withdrawal, selection, and reinsertion during active bleeding.