Safe endoscopic resection of a giant pedunculated colonic polyp after epinephrine volume reduction with clip placement.

Background and Aims: Resection of giant pedunculated colorectal polyps can be challenging because of adverse events such as bleeding and technical difficulties in snaring. Epinephrine injection may reduce tumor size, but its efficacy for giant lesions is limited. Methods: A 59-year-old woman presented with a 50-mm pedunculated polyp in the transverse colon. A total of 20 mL of diluted epinephrine (1:10,000) was injected into the apex and stalk of the polyp, and 6 hemostatic clips were placed near the stalk base. Three weeks later, a follow-up colonoscopy was performed. Results: After a 3-week interval, the polyp exhibited marked shrinkage. En bloc resection was achieved using underwater EMR with a 25-mm snare. Histology revealed a tubulovillous adenoma with negative margins. The patient was discharged without any adverse events. Conclusions: A 5-cm pedunculated colorectal polyp was successfully managed by endoscopic resection 3 weeks after epinephrine volume reduction and clip placement. This method may offer a useful option when immediate resection is not feasible.