This is an 80-year-old woman referred for endoscopy for ablation of a recto-sigmoid adenoma. There is a history of cardiac and pulmonary disease and she presented with rectal bleeding. A colonoscopy performed at an outside institution revealed a large polyp in the region of the recto-sigmoid junction. Biopsy showed this to be a tubular villus adenoma.

With the sigmoidoscope in the rectum we can clearly see the polyp. It is palpable on rectal examination and appears to be soft and friable. We reach the proximal margin of the polyp at approximately ten centimeters from the anal verge. I estimate this polyp to be about eight centimeters long and encompass about one quarter of the circumference of the rectum.

For this polypectomy my preference is to use a small snare for piecemeal resection in order to minimize bleeding. This 15mm snare is a braided wire with barbs that can fix the tissue and prevent the snare from slipping over the top of the polyp. This is particularly important when doing a saline injection that raises the polyp on a bleb of tissue. Normally I use monofilament snares for routine polypectomy to minimize the current density when making the excision, however the barbed snare is available only as braided device.

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