“…Studies that included the patients with bleeding tendencies, abnormal coagulograms, or those undergoing anticoagulant therapy were excluded. An overview of the characteristics of the six studies [14], [15], [16], [17], [18], [19] is given in Table 1.Fig. 1Study selection process.…”
Section: Resultsmentioning
confidence: 99%
“…Four suitable studies with a total of 1062 patients were identified to examine the efficacy of treatment with submucosal epinephrine injection versus treatment with saline injection or no injection [14], [15], [16], [17]. All four studies compared the rate of postpolypectomy bleeding in patients with a polyp size larger than 10 mm.…”
Section: Resultsmentioning
confidence: 99%
“…The analysis of the relevant studies [14], [15], [16], [17] found that the average rate of overall postpolypectomy bleeding complication was 6.2% (66/1062). The rate of overall postpolypectomy bleeding complication in the epinephrine group was 3.4% (% (18/530) and 9.0% (48/532) in the saline/no injection group.…”
Section: Resultsmentioning
confidence: 99%
“…The analysis of the relevant studies [14], [15], [16], [17] found that early postpolypectomy bleeding occurred in 2.8% of patients in the epinephrine group (15/530) and 7.7% of patients in the saline/no injection group (41/532). The polled ORs demonstrated that there was a significant reduction in the rate of early bleeding among those in the epinephrine group (OR = 0.38, 95% CI: 0.20, 0.69; p = 0.002).…”
BackgroundBleeding is the most common major complication following colonoscopic polypectomy. The purpose of this study is to evaluate whether submucosal epinephrine injections could prevent the occurrence of postpolypectomy bleeding.MethodThe dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for appropriate randomized controlled studies published before April 2015. A meta-analysis was conducted to investigate the preventative effect of submucosal epinephrine injection for overall, early, and delayed postpolypectomy bleeding.ResultsThe final analysis examined the findings of six studies, with data from 1388 patients. The results demonstrated that prophylactic treatment with epinephrine injection significantly reduced the occurrence of overall (OR = 0.38, 95% CI: 0.21, 0.66; p = 0.0006) and early bleeding (OR = 0.38, 95% CI: 0.20, 0.69; p = 0.002). However, for delayed bleeding complications, epinephrine injections were not found to be any more effective than treatment with saline injection or no injection (OR = 0.45, 95% CI: 0.11, 1.81; p = 0.26). Moreover, for patients with polyps larger than 20 mm, mechanical hemostasis devices (endoloops or clips) were found to be more effective than epinephrine injection in preventing overall bleeding (OR = 0.33, 95% CI: 0.13, 0.87; p = 0.03) and early bleeding (OR = 0.29, 95% CI: 0.08, 1.02; p = 0.05). This was not established for delayed bleeding.ConclusionThe routine use of prophylaxis submucosal epinephrine injection is safe and beneficial preventing postpolypectomy bleeding.
“…Studies that included the patients with bleeding tendencies, abnormal coagulograms, or those undergoing anticoagulant therapy were excluded. An overview of the characteristics of the six studies [14], [15], [16], [17], [18], [19] is given in Table 1.Fig. 1Study selection process.…”
Section: Resultsmentioning
confidence: 99%
“…Four suitable studies with a total of 1062 patients were identified to examine the efficacy of treatment with submucosal epinephrine injection versus treatment with saline injection or no injection [14], [15], [16], [17]. All four studies compared the rate of postpolypectomy bleeding in patients with a polyp size larger than 10 mm.…”
Section: Resultsmentioning
confidence: 99%
“…The analysis of the relevant studies [14], [15], [16], [17] found that the average rate of overall postpolypectomy bleeding complication was 6.2% (66/1062). The rate of overall postpolypectomy bleeding complication in the epinephrine group was 3.4% (% (18/530) and 9.0% (48/532) in the saline/no injection group.…”
Section: Resultsmentioning
confidence: 99%
“…The analysis of the relevant studies [14], [15], [16], [17] found that early postpolypectomy bleeding occurred in 2.8% of patients in the epinephrine group (15/530) and 7.7% of patients in the saline/no injection group (41/532). The polled ORs demonstrated that there was a significant reduction in the rate of early bleeding among those in the epinephrine group (OR = 0.38, 95% CI: 0.20, 0.69; p = 0.002).…”
BackgroundBleeding is the most common major complication following colonoscopic polypectomy. The purpose of this study is to evaluate whether submucosal epinephrine injections could prevent the occurrence of postpolypectomy bleeding.MethodThe dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for appropriate randomized controlled studies published before April 2015. A meta-analysis was conducted to investigate the preventative effect of submucosal epinephrine injection for overall, early, and delayed postpolypectomy bleeding.ResultsThe final analysis examined the findings of six studies, with data from 1388 patients. The results demonstrated that prophylactic treatment with epinephrine injection significantly reduced the occurrence of overall (OR = 0.38, 95% CI: 0.21, 0.66; p = 0.0006) and early bleeding (OR = 0.38, 95% CI: 0.20, 0.69; p = 0.002). However, for delayed bleeding complications, epinephrine injections were not found to be any more effective than treatment with saline injection or no injection (OR = 0.45, 95% CI: 0.11, 1.81; p = 0.26). Moreover, for patients with polyps larger than 20 mm, mechanical hemostasis devices (endoloops or clips) were found to be more effective than epinephrine injection in preventing overall bleeding (OR = 0.33, 95% CI: 0.13, 0.87; p = 0.03) and early bleeding (OR = 0.29, 95% CI: 0.08, 1.02; p = 0.05). This was not established for delayed bleeding.ConclusionThe routine use of prophylaxis submucosal epinephrine injection is safe and beneficial preventing postpolypectomy bleeding.
“…Epinephrine injection to both the stalk and the polyp head,107 as well as looping108 and clipping67 techniques, have been deployed successfully to reduce the risk of bleeding after hot snare polypectomy. Even though injection of epinephrine may only prevent immediate but not delayed bleeding,109 this is the most widely used preventive method, and many authors prefer reserving other techniques only for high-risk patients 5. Some of the reported factors predisposing patients with large pedunculated polyps to a increased risk of bleeding include older age, type of current used, size and histology of polyps, stalk diameter, and use of anticlotting drugs 108,109…”
The major role of colonoscopy with polypectomy in reducing the incidence of and mortality from colorectal cancer has been firmly established. Yet there is cause to be uneasy. One of the most striking recent findings is that there is an alarmingly high incomplete polyp removal rate. This phenomenon, together with missed polyps during screening colonoscopy, is thought to be responsible for the majority of interval cancers. Knowledge of serrated polyps needs to broaden as well, since they are quite often missed or incompletely removed. Removal of small and diminutive polyps is almost devoid of complications. Cold snare polypectomy seems to be the best approach for these lesions, with biopsy forcep removal reserved only for the tiniest of polyps. Hot snare or hot biopsy forcep removal of these lesions is no longer recommended. Endoscopic mucosal resection and endoscopic submucosal dissection have proven to be effective in the removal of large colorectal lesions, avoiding surgery in the majority of patients, with acceptably low complication rates. Variants of these approaches, as well as new hybrid techniques, are being currently tested. In this paper, we review the current status of the different approaches in removing polypoid and nonpolypoid lesions of the colon, their complications, and future directions in the prevention of colorectal cancer.
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