A Novel Ligation Technique for Endoscopic Resection of Pedunculated Colonic Lesions with a Giant Head: Line-anchored Ligation and Cutting Method

Background and Aims Pre-ligation of the stalk before polypectomy reduces post-polypectomy bleeding in large pedunculated colonic lesions. However, deploying a detachable snare over a giant head to reach the stalk is physically impossible in some cases. We devised a novel technique, termed Line-anchored Ligation and Cutting (LiLAC), that achieves circumferential stalk ligation regardless of head size. Methods A thread anchored to the bowel wall using a clip was wound around the stalk using biopsy forceps and pulled into the instrument channel while the scope tip was pressed against the stalk as a countertraction point, thereby achieving firm circumferential ligation through a single-channel scope (Video 1). Results The technique was applied in a woman in her 70s with a giant pedunculated submucosal tumor in the ascending colon (head diameter: 40 mm; stalk diameter: 8 mm). Marked stalk congestion confirmed successful ligation (Fig. 1). Resection was completed using a high-frequency knife without intraprocedural or delayed bleeding. Histological examination confirmed a lipoma. Conclusions LiLAC enables reliable pre-resection stalk ligation in pedunculated lesions with oversized heads in which conventional detachable snare placement is not feasible.