A Prospective, Randomized Comparison of Adrenaline Injection in Combination with Detachable Snare Versus Adrenaline Injection Alone in the Prevention of Postpolypectomy Bleeding in Large Colonic Polyps.

Abstract

Our data suggest that the use of adrenaline injection in combination with detachable snare may significantly decrease the number of early postpolypectomy bleeding episodes in patients with large colonic polyps.

Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study

“…Combined endoscopic techniques for prevention of postpolypectomy bleeding are of great interest. The study from Paspatis et al [23] was the first to evaluate the combination of two hemostatic, prophylactic techniques, which is used with efficacy in bleeding ulcers [30]. In our study, combined endoscopic methods were superior to adrenaline injection alone for both early and late bleeding episodes, severity of bleeding, and need for blood units.…”

“…However, in a randomized controlled trial, prophylactic clip placement did not decrease the occurrence of delayed bleeding after colonoscopic polypectomy. Di Giorgio et al [13] showed similar efficacy of adrenaline injection and detachable snare placement, whereas Paspatis et al [23] showed superiority of combined adrenaline injection and detachable snare placement over adrenaline injection alone in postpolypectomy bleeding of large pedunculated polyps. Combined endoscopic techniques for prevention of postpolypectomy bleeding are of great interest.…”

“…Di Giorgio et al [13] showed similar efficacy of adrenaline injection and endoloop placement, whereas Paspatis et al [23] showed that combined adrenaline and loop placement were superior to adrenaline injection alone in large colonic polyps.…”

Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study

“…18 Nonetheless, the use of adrenaline injection in combination with detachable snare may significantly decrease the number of early post-polypectomy bleeding episodes, in patients with large colonic polyps. 19 There is a retrospective study 9 that endorse the use of hemoclips because their prophylactic use is associated with a low risk of bleeding following the endoscopic resection of large pedunculated polyps. However, a recent article 20 submitted as an abstract to DDW 2011 (Digestive Disease Week), comparing the use of the endoloop to the hemoclip (prospective randomized study) concludes that there are no differences in both techniques in terms of effectiveness and safety.…”

Approaching polyps in the time of discrimination

“…Submucosal injection, endoclip and endoloop placement potentially reduce the procedure-related bleeding in difficult to treat lesions (53)(54)(55)(56) but there are no agreed guidelines available currently which can recommend a specific technique (57). Also, the literature on "difficult colon polypectomy" demonstrates that this concept lacks a clear-cut definition.…”