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

Kouklakis, George; Mpoumponaris, Alexandros; Gatopoulou, Anthia; Efraimidou, Eleni; Μανωλασ, Κωνσταντινοσ; Lirantzopoulos, Nikolaos

doi:10.1007/s00464-009-0478-3

Cited by 108 publications

(67 citation statements)

References 28 publications

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“…16 With regard to adrenaline injection compared to endoloop and hemoclip a prospective study, 3 has shown that there are no differences between both techniques in post-polypectomy bleeding prophylaxis, although the combination of both procedures appears to be more efficient. 17 Several studies compared detachable snare versus epinephrine injection, reporting no difference in delayed post-polypectomy and similar efficacy either by placing endoloops or by injecting epinephrine.…”

Section: Discussionmentioning

confidence: 99%

“…3 Therefore, based on an anticipated decrease of at least 12% in the rate of adverse bleeding events between the group treated using hemoclips and the group treated using conventional methods, there was an alpha error of 0.05 and a statistical power of 80% (beta error of 0.2) with a patient inclusion rate of 1:1. The number of polyps required is 146 per group.…”

Section: Statistical Considerationsmentioning

confidence: 99%

“…The immediate or delayed bleeding ranges from 0.3%-6.1%, 3 which in some studies reaches 12%, 4 increasing to 24% in polyps larger than 3 cm. 5 Perforation is less frequent, with a rate of less than 1%.…”

Section: Introdutionmentioning

confidence: 97%

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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

jig

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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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Section: Discussionmentioning

confidence: 99%

Section: Statistical Considerationsmentioning

confidence: 99%

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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

jig

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“…L'association la plus utilisée dans ce cas est l'injection du pied du polype avec 2 à 5 ml de sérum salé isotonique additionné d'adrénaline (1/10 000), associée à la mise en place d'une anse d'hémostase (Polyloop) [11]. La coupe peut être augmentée à 200 W si le pied du polype est large (> 1 cm).…”

Section: Indications Et Techniques Endoscopiques Polypectomieunclassified

Polypectomie et mucosectomie

Barrioz¹,

Coumaros²

2011

Acta Endosc

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“…Prophylactic measures like adrenaline injection [22][23][24][25][26][27] or mechanical haemostasis [23][24][25] to prevent PPH have been studied, but have not been universally adopted, or recommended in guidelines. One meta-analysis examined the use of prophylactic haemostatic measures in preventing PPH, 28 but included smaller polyps (<10 mm) which are less likely to bleed.…”

Section: Introductionmentioning

confidence: 99%

Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta‐analysis

et al. 2014

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Background and aim: Postpolypectomy haemorrhage (PPH) is a known adverse event that can occur following polypectomy, occurring in 0.3-6.1% of cases. Previous meta-analysis has included small polyps, which are less likely to bleed, and less amenable to some methods of mechanical haemostasis. No comprehensive cost-benefit analysis of this topic is available. The aim of this study was to perform a meta-analysis of randomized trials and a cost-benefit analysis of prophylactic haemostasis in PPH. Methods: A total of 3092 abstracts from prospective trials conducted in human colonoscopic polypectomy were screened. Outpatients undergoing polypectomy in seven suitable studies (1426 episodes), without polyposis syndromes or bleeding diathesis, were identified. The interventions of prophylactic haemostatic measures (clips, loops, and/or adrenaline injection) to prevent PPH were assessed. The main outcome measurements were PPH measured by haematochezia or drop in haematocrit >10% or haemoglobin >1 g/dl. Risk ratio and number needed to treat (NNT) were generated using metaanalysis. Results: Comparing any prophylactic haemostasis to none, the pooled risk ratio for PPH was 0.35 (0.21-0.57; p < 0.0001), NNT was 13.6, and cost to prevent one PPH was USD652. Using adrenaline alone vs. no prophylactic haemostasis revealed a pooled risk ratio of 0.37 (0.20-0.66; p ¼ 0.001), NNT 14.0, cost to prevent one PPH USD382. Any prophylactic mechanical haemostasis compared to adrenaline produced a RR for PPH of 0.28 (0.14-0.57; p < 0.0001), NNT 12.3, and cost to prevent one PPH USD1368. Conclusions: Adrenaline injection or mechanical haemostasis reduces the risk of PPH. Routine prophylactic measures to reduce PPH for polyps larger than 10 mm are potentially cost effective, although more thorough cost-benefit modelling is required.

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

Abstract: Combined endoscopic techniques seem to be more effective in preventing postpolypectomy bleeding in large pedunculated colonic polyps.

Cited by 108 publications

References 28 publications

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

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

Polypectomie et mucosectomie

Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta‐analysis

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