Facciorusso A, Di Maso M, Antonino M, Del Prete V, Panella C, Barone M, Muscatiello N. Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis.
Gastrointest Endosc 2015;
82:350-358.e2. [PMID:
25910664 DOI:
10.1016/j.gie.2015.01.003]
[Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND
EMR is the standard of care for the resection of large polyps.
OBJECTIVE
To compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare.
DESIGN
After 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection.
SETTING
Endoscopic suite at the University of Foggia between 2005 and 2014.
PATIENTS
Of 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching.
INTERVENTIONS
Submucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients.
MAIN OUTCOME MEASUREMENTS
Univariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB).
RESULTS
The 2 groups presented similar baseline clinical parameters and lesion characteristics. All patients had a single polyp 20 mm or larger; the median size was 32 mm (interquartile range [IQR], 25-38) in the polidocanol group and 32 (IQR, 24-38) in the epinephrine group (P=.7). Polidocanol was more effective in preventing both immediate and delayed PPB (P<.001 and P=.003, respectively), and its efficacy was confirmed in almost all of the subgroups, regardless of polyp size and histology. Postprocedure perforation was observed in 2 patients (0.3%), both in the epinephrine group (P=.49). The 2 groups did not differ in the number of snare resections of lesions or the procedure duration (P=.24 and .6, respectively).
LIMITATIONS
Absence of randomization.
CONCLUSION
The submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate.
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