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Gastrointestinal: Endoscopic removal of a stuck colonoscope

A 54-year-old man underwent colon cancer screening, and a 4-cm pedunculated polyp (Fig. 1a) was identified at the transverse colon. One detachable nylon loop was placed in the stalk (Fig. 1b) before resection. However, the nylon loop failed to detach from the ligating device. After a series of attempts to straighten the colonoscope and detach the loop-ligating device, the operator still failed to remove the ligating device, and the colonoscope finally got stuck in the colon. The patient experienced severe abdominal pain, while further changing the position of the colonoscope. Therefore, the patient was referred to our hospital for further therapy. We inserted a pediatric colonoscope (Olympus, PCF-Q260JI); the previous colonoscope was tightly stuck, along with the deformed ligating device and the colon polyp (Fig. 2a, Video S1). We placed another diathermy snare to attempt pruning of the polyp to relieve the stuck colonoscope. While the snare was positioned, the polyp eventually changed position; then, the ligating device was gradually released, and the deformed nylon loop remained in place (Fig. 2b). Finally, the stuck colonoscope was removed smoothly, and the polyp was resected. Colonoscopy can effectively prevent further development of colon cancer. The detachable nylon loop was developed for the endoscopic resection of large pedunculated polyps to decrease the rate of polypectomy bleeding. However, using a detachable snare can lead to several complications; most of these complications are related to the ineffective use of the loop, causing early post-polypectomy hemorrhage. Furthermore, manipulating the detachable loop can possibly result in technical complications, such as the entanglement of the loop with the diathermy snare and failure to release the loop. Although the loop can generally be released after trimming the ligating device, a rare complication, that is, the undesirable adherence of an entire colonoscope to the colon surface after such management may occur, similar to this case. In such situations, using a small-caliber scope, such as a gastroscope or pediatric colonoscope, can help relieve this difficult situation before sending the patient for surgery.