Combination of adrenaline injection and detachable snare application as haemostatic preventive measures, before polypectomy of large colonic polyps in children

Combined endoloop and endoclip application for prevention of postpolypectomy bleeding

AIM: To evaluate the value of combined endoloop and hemoclip application as a prophylactic method for postpolypectomy bleeding in patients with large (≥2 cm) pedunculated colonic polyps.

METHODS: Patients with pedunculated colonic polyps (≥2 cm) were included in this study retrospectively and divided into a control group and an experimental group. In the control group, endoclips were used after conventional polypectomy. In the experimental group, an endoloop was placed at the base of the stalk followed by conventional polypectomy and clip application in the residual stalk above the snare. The efficacy in preventing early and late postpolypectomy bleeding, rate of severe bleeding, and days of hospitalization were evaluated.

RESULTS: Overall, bleeding complications occurred in 5/72 polyps (6.94%). In the control group (endoclips alone), 4/42 (9.52%) had a bleeding episode: three (7.14%) occurred during the first 24 h and one (2.3%) between days 1 and 30 from the procedure. In the experimental group only 1 of 32 polyps (3.12%) had a late bleeding episode (P = 0.275). Severity of late bleeding in the experimental group (one case of moderate bleeding) vs the control group (3 cases of moderate and one case of severe bleeding) and need for transfusions (0 vs 2 blood units) were lower. Colonoscopy time was significantly higher in the experimental group vs the control group (P = 0.027), but hospitalization days were shorter in the experimental group (P = 0.047).

CONCLUSION: Endoloop combined with endoclip technique seems to be more effective than endoclip alone in preventing postpolypectomy bleeding in large pedunculated colonic polyps.

Postpolypectomy bleeding: incidence, risk factors, prevention, and management

Endoscopic polypectomy is at the forefront of colorectal cancer (CRC) prevention. However, endoscopic polypectomy is not completely free of complications, with bleeding being one of the most common complications encountered. In view of the ongoing campaign to introduce colorectal cancer screening to the population, addressing the issue of colonoscopic complications, and postpolypectomy bleeding (PPB) in particular is becoming more important. Despite the fact that the overall incidence of PPB is low, predisposing factors need to be elucidated to further decrease the frequency of this complication. Furthermore, the role of various techniques of PPB prophylaxis remains controversial. We review recent studies on the incidence, risk factors, prophylaxis, and management of PPB.