Combination of Adrenaline Injection and Detachable Snare Application as Haemostatic Preventive Measures, Before Polypectomy of Large Colonic Polyps in Children

Abstract

Juvenile polyps are the most common type of polyps encountered in childhood, found approximately, in 1% of the pediatric population [1]. There is a male predominance [1] and the peak age of occurrence ranges between 2-6 years [1]. Painless rectal bleeding is the most common symptom, found in 90% of cases [1]. With the advent of the colonoscopy, it has been noticed that >50% of the children have >1 polyp and about 60% of the polyps are located proximal to the rectosigmoid [2]. Because juvenile polyps are usually pedunculated, colonoscopic removal is a common and safe practice [2]. Postpolypectomy bleeding is the most common complication of endoscopic polypectomy [3]. Several studies in adults have shown that the size of the polyp is a risk factor for postpolypectomy bleeding [4]. To minimize the risk of postpolypectomy bleeding, several new techniques have been proposed. These include application of detachable snares or endoclips, injections of adrenaline solutions, and several thermal modalities. We report 4 cases of children with large pedunculated colonic polyps, removed endoscopically, having received an adrenaline injection which was administered locally and the application of a detachable snare, to minimize the risk of postpolypectomy bleeding. Then polypectomy was performed using a standard snare