Clip-and-pull method: re-strangulation of a sizable small-bowel polyp for endoscopic ischemic polypectomy

Double-balloon endoscopy (DBE) facilitates safe endotherapy of small-bowel polyps [1]. Endoscopic ischemic polypectomy (EIP) with detachable snares or clips is useful as a secure and safe method for treating benign polyps [2] [3] [4], especially in patients with Peutz–Jeghers syndrome, who require polyp management to avoid intussusception [5]. However, EIP with detachable snares in the small bowel may be technically challenging. Furthermore, initial strangulation and resultant shrinkage of the lesion may loosen the ligature, and this may result in incomplete ischemia. In this situation, re-strangulation is required.