Endoloop-assisted polypectomy for large pedunculated colorectal polyps

Katsinelos, Panagiotis; Kountouras, Jannis; Paroutoglou, George; Beltsis, Athanasios; Chatzimavroudis, Grigoris; Zavos, Christos; Vasiliadis, Ioannis; Katsinelos, Taxiarchis; Papaziogas, B.

doi:10.1007/s00464-005-0713-5

Cited by 51 publications

(40 citation statements)

References 21 publications

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“…On the basis of our results, it is possible to consider endoloop-assited polypectomy in large pedunculated colorectal polyps a safe procedure, irrespective of the diameter of the stalk, contrasting with the data from Katsinelos et al [1] and Matsushita et al [5], but in accordance with Rey and Marek [6] and Iishy et al [7]. Probably, our data are the result of a methodological approach to this technique different from Katsinelos et al [1]: in fact we approach all polypertomies with the same fear of precipitating hemorrhage irrespective of the application of the endoloop.…”

contrasting

confidence: 84%

“…Thus, by rereading in this manner the results reported by Katsinelos et al [1], endoloop appears ineffective in comparison with Matsushita et al [5] and in contrast to the results reported by Rey and Marek [6] and by Iishy et al [7] in the only published randomized trial (no bleeding in the 47 patients in the endoloop arm and five cases of bleeding in the 42 patients of the control arm), the largest series until now available.…”

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confidence: 43%

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Endoloop-assisted polypectomy for large peduncolated colorectal polyps

2007

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We were very interested in reading the recent paper by Katsinelos et al. [1] regarding the technique of endoloopassisted polypectomy in large pedunculated colorectal polyps. In summary, the Authors data suggest ''that although colonoscopic resection of large peduncuolated polyps using an endoloop is safe and effective, the problems encountered with this method show some of the limitations encountered with endoscopic therapy in preventing postpolypectomy bleeding when currently available instruments are used''. Nevertheless, by reading and re-reading the paper: a) 33 patients with large pedunculated polyps were enrolled; b) four were excluded because of narrow sigmoid lumen and polyp head size, precluding endoloop placement; c) in one patient the endoloop entangled with the snare, precluding enbloc resection; d) in the remaining 28 patients, two bled immediately because of inadvertent transection of the thin stalk (<4 mm) with the tightening of the endoloop, and two showed delayed bleeding because of slipping of the endoloop. In conclusion: a) in more than 12% of the case endoloop can not be placed; b) placement of the endoloop can preclude en-bloc resection of the polyp; c) in two cases (7.1%) the endoloop was the cause of bleeding, and in another two, the endoloop was not able to prevent delayed bleeding, thus, globally, bleeding occurred in four (14.3%) out of 28 patients. Taking into account that bleeding is reported to occur immediately in about two percent of the cases after snaring [2], bleeding caused by the endoloop (due to inadvertent transection of the stalk) in 7.1% of the cases suggests that the procedure is not safe. Moreover, taking into account that, globally, post-polypectomy bleeding without endoloop application is reported to occur in 0.3 to 6.1% of the cases [3, 4], a bleeding rate of 14.3% with the use of the endoloop suggests that the endoloop is not effective. In

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confidence: 84%

mentioning

confidence: 43%

Endoloop-assisted polypectomy for large peduncolated colorectal polyps

2007

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“…These conclusions were observed in subsequent retrospective studies. 14 However, the use of the endoloop could pose greater technical difficulties due to transection by the loop of a thin stalk before the polypectomy or insufficient tightening of the loop. 15 Moreover, we must remember that there are difficulties in looping big polyps with the endoloop and in the ultimate subsequent snaring of the polyp.…”

Section: Discussionmentioning

confidence: 99%

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

Quintanilla¹,

Castro²,

Rábago³

et al. 2012

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Background:The methods for preventing post-polypectomy bleeding (PPB) are not standardised and there are groups that use hemoclips for this purpose. Objective: To study whether the use of hemoclips reduces PPB complications. Materials and Methods: Prospective, randomised study of patients with pedunculated polyps larger than 10 mm. The patients were included in two groups (hemoclip before polypectomy -HC-and standard polypectomy -SP-). This study has been registered with the trial registration number NCT01565993. Results: 105 polypectomies were performed (98 patients), 66 (62.9%) in the HC group. The total rate of complications was 10,6% in the HC group (4.5% early bleeding, 1.5% severe delayed bleeding, 4,5% mucosal burns, 1.5% perforation). In the SP group, the rate of total complications was 7,7%, (7,7% early bleeding, no significant differences). In view of the unexpected increase in the morbidity of the hemoclip group, the study was suspended without reaching the sample size. In an ad hoc analysis, which includes the standard polypectomy patients who refused to participate in the study (35 polyps), the total morbidity was 5,7% (no perforations and 2 patients with premature bleeding).When we compared the morbidity of the HC group to the morbidity of SP group plus R group (74 polyps), we also failed to detect any significant differences in terms of PPB, but did in terms of perforation. Conclusion:The prophylactic use of hemoclips in polypectomies of large pedunculated polyps leads to a further risk of mucosal burns and perforation that is not acceptable, and does not reduce the risk of PPB.

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“…The pre-tied ligature systems, also known as endoscopic slipknots or "endoloops", are composed of a slipknot and a laparoscopic tool used to guide and tighten the knot, which is known as knot pusher (KATSINELOS et al, 2006). Hemostasis is achieved by pushing and tightening the knot around the ovarian pedicle.…”

Section: Clinic and Surgerymentioning

confidence: 99%