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

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) wererandomized 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.

Risk factors for incomplete polyp resection during colonoscopy

Colonoscopic polypectomy is extremely effective in protecting against colorectal cancers,and recognition of adenomas by colonoscopy is of paramount importance in preventing colorectal cancer(CRC)and CRC-associated mortality.Incomplete polyp resection(IPR)occurs routinely in medical practice following polypectomy.We conducted a comprehensive literature search to identify studies that reported on the potential risk factors for IPR using MEDLINE,EMBASE,and PubMed.Publication time was limited between January 2004 and July 2021.Our search revealed assessments of the position,morphology,and histologic variation of the polypsdas well as the relevant skills that may interfere with IPR.The included studies showed that colonic polyps with a diameter>20 mm and proximal in location should be dealt with cautiously.For smaller polyps,cold-snare polypectomy appeared to be the most effective method used to accomplish comprehensive polyp removal.In addition,endoscopist experience in narrow-band imaging in polyp detection were also associated with IPR.Therefore,polypectomy should be performed cautiously if the polyp growth is expected to be cancerous and situated in the proximal portion of the colon or rectum,and modalities should be standardized so as to lower the potential risk for IPR.