Novel gel-flush rescue technique for an impacted detachable snare sheath in the working channel during polypectomy

Detachable snares prevent bleeding during endoscopic resection of pedunculated polyps [ 1​ ] and achieving hemostasis in colonic diverticular bleeding.[ 2​ ] Mechanical failures (e.g., inability to release the loop) rarely occur.[ 3​ ] Typically, the device is cut proximally, the endoscope is withdrawn, and the loop is severed upon reinsertion. However, if the cut sheath completely retracts into the working channel and becomes jammed, endoscope withdrawal applies direct traction to the polyp stalk, creating a high risk of unintended transection, bleeding, or perforation. A 54-year-old woman underwent polypectomy for an approximately 20-mm pedunculated polyp in the ascending colon ([ Fig. 1 ]) ([ Video 1 ]). A detachable snare (PolyLoop Ligating Device; Olympus, Tokyo, Japan) applied to the stalk prevented bleeding ([ Fig. 2a ]). As the loop could not be released ([ Fig. 2b ]), the device was cut proximally ([ Fig. 3 ]). Immediately after the sheath was retracted into the channel, strong resistance was felt upon attempting scope withdrawal. To prevent perforation from excessive tension on the polyp, withdrawal was aborted. Strong resistance inside the instrument port prevented pushing the sheath with grasping forceps. Flushing water (1 mPa·s) through the port was ineffective because of leakage around the sheath. We forcefully injected a highly viscous gel (VISCOCLEAR; Otsuka Pharmaceutical Factory, Tokushima, Japan) directly into the biopsy valve using a 50-mL syringe. The gel’s high viscosity (768 mPa·s) [ 4​ ] physically sealed the gaps, effectively transmitting the hydraulic pressure from the syringe into a forward propulsive force, successfully extruding the jammed sheath into the colon. After safe scope withdrawal and reinsertion, the polyp stalk was resected between the ligated loop and mucosal base using a scissor-type knife. The polyp was retrieved along with the snare without complications ([ Fig. 4 ]). This novel technique, utilizing the gel’s high viscosity and hydraulic pressure, is a simple and highly effective rescue strategy for jammed devices. Fig. 1 White light image showing a pedunculated polyp, approximately 20 mm in size, in the ascending colon. Video 1 Novel gel-flush rescue technique for an impacted detachable snare sheath in the working channel during polypectomy. Download Video Fig. 2 ( a ) Polyp stalk ligation using a detachable snare. ( b ) Failure of the loop release, showing the wire abnormally coiled within the sheath. Fig. 3 Extracorporeal transection of the device (benchtop demonstration). The sheath of the detachable snare was cut with scissors near the handle. Fig. 4 Macroscopic view of the retrieved specimen. The detachable snare was tightly ligated to the polyp and the wire was abnormally coiled within the sheath. Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AB Publication History Received: 15 May 2026 Accepted after revision: 02 June 2026 Article published online: 23 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany