Comparison of prophylactic clip and endoloop application for the prevention of postpolypectomy bleeding in pedunculated colonic polyps: a prospective, randomized, multicenter study

Abstract

ClinicalTrials.gov (NCT01406379).

Comparison of clipping with and without epinephrine injection for the prevention of post‐polypectomy bleeding in pedunculated colon polyps

“…Several endoscopic preventive methods, such as injection of an epinephrine‐saline solution in the stalk, the use of an endoloop and clipping over the stalk, have been performed before polypectomy because of the high risk of PPB following polypectomy in cases with large pedunculated polyps. Submucosal injection of epinephrine solution into the stalk causes vasoconstriction and mechanical compression of the polyp vessels, resulting in reduced blood flow and lower incidence of PPB .…”

“…Submucosal injection of epinephrine solution into the stalk causes vasoconstriction and mechanical compression of the polyp vessels, resulting in reduced blood flow and lower incidence of PPB . Endoloop ligation is thought to be the most effective technique in the prevention of PPB, but its use might be limited in narrowed colon lumen or over polyps with a large head size . An alternative to these techniques is to place clips on the stalk before snare polypectomy to stop blood flow in the stalk, which is the same principle as that of the endoloop placement .…”

“…A total of 158 patients with large pedunculated colorectal polyps (≥ 10 mm in head diameter) at the Severance Hospital at Yonsei University College of Medicine and the Sanggye Paik Hospital at Inje University College of Medicine were prospectively enrolled in the present study from March 2011 to January 2013. Exclusion criteria included < 18 years of age, severe coagulopathy (international normalized ratio [INR] > 1.5 or platelet count < 50 000 cell/cubic millimeters), chronic renal failure (serum creatinine > 3 mg/dL for > 6 months or receiving dialysis), liver cirrhosis, coexisting colorectal cancer, and taking an oral anticoagulant.…”

Assessment and management of the malignant colorectal polyp

“…Polyps with thick stalks may require endoscopic pretreatment with dilute adrenaline injection to reduce the risk of periprocedural bleeding 23. Application of clips or an endoloop are alternative strategies to prevent bleeding; however, placing these prior to resection may impede the resection process.…”

Prediction and Prevention of Postpolypectomy Bleeding: Current Challenging Issues

“…A few randomized studies comparing these methods have been reported [10, 11, 12, 13, 14]. Each method has its own efficacy and its own advantages in reducing the risk of PPB; however, none of these methods is totally superior to the others.…”