Key Takeaways
- Clinical Bottom Line
- The Therapeutic Armamentarium
Clinical Bottom Line
| Instrument Class | Mechanism of Action | Primary Indications |
|---|---|---|
| Polypectomy Snares | Mechanical strangulation +/- electrocautery. | Cold snare polypectomy for diminutive polyps; hot snare for larger lesions. |
| Hemoclips (TTS) | Mechanical tissue approximation and vessel compression. | Hemostasis of bleeding ulcers; prophylactic closure of large mucosal defects. |
| Injection Needles | Submucosal fluid expansion. | Lifting sessile polyps prior to EMR/ESD; injecting epinephrine for hemostasis. |
The Therapeutic Armamentarium
The transition of endoscopy from a purely diagnostic modality to a highly therapeutic specialty is driven by the evolution of Through-The-Scope (TTS) instrumentation. Gastroenterologists utilize a vast array of single-use, sterile devices deployed through the endoscope’s working channel to execute complex resections and hemostasis.
Polypectomy Snares and EMR Technique
Polypectomy snares are customized by shape (oval, hexagonal, crescent) and wire stiffness to accommodate different polyp morphologies. For polyps under 10mm, cold snare polypectomy has universally replaced hot snaring, offering superior safety profiles with zero risk of delayed thermal injury. For larger sessile lesions, specialized stiffer snares are utilized during Endoscopic Mucosal Resection (EMR) following submucosal injection.
Hemostasis and Clip Application
Through-the-scope hemoclips are essential for the management of non-variceal upper GI bleeding and post-polypectomy hemorrhage prevention. Modern clips feature rotational control and repositioning capabilities, allowing endoscopists to precisely target the bleeding vessel or securely approximate the mucosal edges of a broad resection base.
Clinical guidelines summarized by the Gastroscholar Research Team. Last updated: 2026. This article is intended for physicians.
