Comparison of postpolypectomy bleeding between epinephrine and saline submucosal injection for large colon polyps by conventional polypectomy: a prospective randomized, multicenter study

World J Gastroenterol. 2007 Jun 7;13(21):2973-7. doi: 10.3748/wjg.v13.i21.2973.

Abstract

Aim: To evaluate and compare the clinical outcomes of prophylactic submucosal saline-epinephrine injection and saline injection alone for large colon polyps by conventional polypectomy.

Methods: A prospective study was conducted from July 2003 to July 2004 at 11 tertiary endoscopic centers. Large colon polyps (> 10 mm in diameter) were randomized to undergo endoscopic polypectomy with submucosal saline-epinephrine injection (epinephrine group) or normal saline injection (saline group). Endoscopic polypectomy was performed by the conventional snare method, and early (< 12 h) and late bleeding complications (12 h-30 d) were observed.

Results: A total of 561 polyps in 486 patients were resected by endoscopic polypectomy. Overall, bleeding complications occurred in 7.6% (37/486) of the patients, including 4.9% (12/244) in the epinephrine group, and 10.3% (25/242) in the saline group. Early and late postpolypectomy bleeding (PPB) occurred in 6.6% (32/486) and 1% (5/486) of the patients, respectively, including 4.5% (11/244), 0.4% (1/244) in the epinephrine group, and 8.7% (21/242), 1.7% (4/242) in the saline group. No significant differences in the rates of overall, early and late PPB were observed between the 2 groups. Multivariate stepwise logistic regression analysis revealed that large size (> 2 cm) and neoplastic polyps were independently and significantly associated with the presence of PPB.

Conclusion: The prophylactic submucosal injection of diluted epinephrine does not appear to provide an additional advantage over the saline injection alone for the prevention of PPB.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Colon / pathology
  • Colon / surgery
  • Colonic Polyps / surgery*
  • Colonoscopy / adverse effects*
  • Colonoscopy / methods
  • Epinephrine / administration & dosage
  • Epinephrine / therapeutic use*
  • Female
  • Humans
  • Injections
  • Intestinal Mucosa / blood supply
  • Intestinal Mucosa / drug effects
  • Logistic Models
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / prevention & control*
  • Prospective Studies
  • Sodium Chloride / administration & dosage
  • Sodium Chloride / therapeutic use*
  • Vasoconstrictor Agents / administration & dosage
  • Vasoconstrictor Agents / therapeutic use*

Substances

  • Vasoconstrictor Agents
  • Sodium Chloride
  • Epinephrine