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Polypectomy & Hot Biopsy

Polypectomy and hot biopsies have become routine electrosurgery procedures used for the removal of polyps. While polypectomy is done to remove flat and pedunculated polyps, hot biopsies are done to remove very small polyps (with a diameter up to 5 mm).

During polypectomy, an electrosurgical snare is advanced to the polyp under endoscopic guidance and pressed onto it or snared around it. A high-frequency electric current is then passed through the snare while the snare is tightened. This rapidly and safely excises the polyp while thermally coagulating the underlying vasculature.

Resection of a stalked polyp #1

Resection of a stalked polyp #1

Resection of a stalked polyp #2

Resection of a stalked polyp #2

Resection of a stalked polyp #3

Resection of a stalked polyp #3

Resection of a stalked polyp #4

Resection of a stalked polyp #4

This technique causes a minimal amount of bleeding. It is vital to start the high frequency electric current when closing the snare in order to avoid a ‘cold cut’, which may cause bleeding. Once released from the mucosal surface, the polyp may be retrieved.


Different polyps require different snares for successful removal. Rigid and twisted wire snares make the resection of flat lesions easier as they can be pushed onto the lesion and securely snag the mucosa.

Injection into the submucosa to lift up a flat lesion prior to resection #1

Injection into the submucosa to lift up a flat lesion prior to resection #1

Injection into the submucosa to lift up a flat lesion prior to resection #2

Injection into the submucosa to lift up a flat lesion prior to resection #2

Injection into the submucosa to lift up a flat lesion prior to resection #3

Injection into the submucosa to lift up a flat lesion prior to resection #3

Rigid snare pushed onto a flat polyp

Rigid snare pushed onto a flat polyp

Softer, more pliable wires require less force to open and close them. Thick wire diameters minimise bleeding during the cut, while thinner wire diameters ensure a rapid, clean cut. Crescent-shaped snares can be used to capture flat lesions in conjunction with a distal attachment during endoscopic mucosal resection.

If a polyp is exceptionally large it is not recommended to resect it in one step. A large polyp is usually supplied by a big blood vessel and a complete one-step resection is very likely to cause a big bleeding. Therefore the gold standard for large polyps nowadays is a piecemeal resection, which minimises the risk of strong bleedings and ensures a good field of view and complete control during the whole procedure.

Polyps of an exceptional size are recommended to be resected via a piecemeal resection

Polyps of an exceptional size are recommended to be resected via a piecemeal resection

To minimise bleedings the polyp is resceted step by step

To minimise bleedings the polyp is resceted step by step

This is the safest way to completely resect a big polyp

This is the safest way to completely resect a big polyp

Olympus supplies a range of single-use snares and hot biopsy forceps to suit every eventuality. Standard, soft, spiral and crescent snares are available in a wide range of sizes with different loop shapes and wire stiffnesses and Olympus also supplies disposable hot biopsy forceps. The snares and forceps have been designed with a flexible sheath, which allows smooth insertion and passage of the snare through the endoscope, without causing damage.

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