Endoscopic ischemic polypectomy using a large endoclip for Peutz–Jeghers polyps

Hamartomatous polyps seen in Peutz–Jeghers syndrome are called Peutz–Jeghers polyps (PJPs), and PJPs 15 mm or larger in size may cause intestinal intussusception that requires surgical treatment. The usefulness of balloon-assisted enteroscopy has been reported for PJPs in the small intestine [1]. Although endoscopic resection was the conventional treatment for PJP, endoscopic ischemic polypectomy (EIP), namely the strangulation of the polyps using endoclips without resection, is now preferred for PJPs because of the need to treat many PJPs at one endoscopic session [2]. For polyps with large stalks, conventional clips may not provide sufficient ischemia even with repeated clipping, resulting in the need for snare ischemia [3]. However, the snare technique takes a longer time and is challenging to perform because of the difficulty in obtaining adequate endoscopic images of large polyps and the limited maneuverability of the endoscope [2]. Moreover, if ligation with a snare fails, the snare cannot be reopened and must be discarded, representing a treatment failure. Recently, the SureClip (Micro-Tech) has been developed as a novel endoclip that rotates smoothly and can be reopened after grasping tissue. Although its usefulness in endoscopic treatment has been reported [4] [5], the utility of this device in EIP for PJPs is unclear. The SureClip has available a longer clip width (16 mm) than conventional clips and allows reopening and repositioning, making it easier to achieve strong clamping of the polyps. We report on EIP for PJPs, using the longer clip ([Video 1]).