Efficacy of submucosal epinephrine injection for the prevention of postpolypectomy bleeding: A meta-analysis of randomized controlled studies

Abstract

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.

Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection

“…However, the delayed bleeding rate in the non-epinephrine and epinephrine groups was not significantly different (both 6 %). A recent meta-analysis of six randomized controlled trials showed that epinephrine injection significantly reduced the occurrence of early bleeding but not of delayed bleeding 26 . Epinephrine has a short duration of action of 5 to 10 minutes; therefore, we considered that epinephrine injection would not be effective for reduction of delayed bleeding of gastric ESD.…”

Solutions for submucosal injection: What to choose and how to do it

“…ESGE guidelines recommend the use of diluted epinephrine before hot-snare polipectomy of large pedunculated polyps (head size ≥ 20mm or stalk width ≥ 10mm), but there is no mention regarding the systematic need for its injection in other types of lesions. A recent meta-analysis concluded that the application of submucosal epinephrine injection before resecting larger polyps (≥ 20 mm) as a routine procedure is helpful to reduce the occurrence of early postpolipectomy bleeding[35]. However, in this meta-analysis injection of diluted epinephrine was not shown to significantly reduce the risk of delayed postpolipectomy bleeding.…”

Current strategies for malignant pedunculated colorectal polyps

“…A recent meta-analysis of three randomized controlled studies[64] that compared the efficacy of epinephrine injection and mechanical hemostasis in postpolypectomy bleeding in patients with pedunculated polyps over 20 mm demonstrated that prophylactic treatment with mechanical hemostasis is more effective than epinephrine injection for preventing overall postpolypectomy bleeding (2.2% vs 6.3%) and early postpolypectomy bleeding (1.1% vs 4.5%). The rate of delayed postpolypectomy bleeding was 1.9% in the epinephrine group and 1.1% in the mechanical group, and their implementation was not found to significantly affect the rate of delayed postpolypectomy bleeding (OR = 0.58, 95%CI: 0.13, 2.49; P = 0.46) without significant heterogeneity between the studies ( P = 0.94, I 2 = 0%).…”

“…Different risk factors for postpolypectomy complications, such as old age (older than 65 years of age), underlying diseases (cardiovascular or chronic renal disease), anticoagulant use, polyp size > 10 mm, a stalk size > 5 mm, polyps located on the right side of the colon, malignant polyps, use of cutting mode and low-volume endoscopists, have been described[47,64-67].…”