title: Endoscopic ultrasonography for prediction of postpolypectomy bleeding in patients with large nonpedunculated rectosigmoid adenomas.
abstract: OBJECTIVE
  Case reports suggest that endosonographic visualization of blood vessels in a gastric polyp may be predictive of risk of postpolypectomy bleeding; however, this issue has never been studied in patients with colorectal adenomas.
  
  
  METHODS
  Endosonography (EUS) was performed prior to endoscopic polypectomy of 42 large (>/= 20 mm) nonpedunculated adenomatous polyps. The median diameter of the polyps was 30 mm (range 20-100 mm); 35 were located in the rectum and seven in the sigmoid colon. During EUS both the polyp and the bowel wall underneath were searched for the presence of vessels, which were defined as longitudinal/tortuous or round/oval echo-free structures >/= 2 mm in diameter.
  
  
  RESULTS
  The polyp was visualized adequately in 39 cases; three cases were excluded from analysis due to inadequate visualization. In eight polyps (20.5%, group 1) EUS revealed vessels measuring 2-4 mm; in 31 polyps (79.5 %, group 2) no vessels were found. The postpolypectomy bleeding incidence (per polyp treated) was 12.5% in group 1 and 12.9 % in group 2 (P>0.05).
  
  
  CONCLUSIONS
  In this small series of patients with large nonpedunculated rectosigmoid adenomas, the EUS image of the polyp was not predictive of postpolypectomy bleeding. The detection of vessels on EUS did not increase the risk for bleeding; however, the sample size was to small to draw definite conclusions. The absence of vessels on EUS did not rule out the possibility of bleeding.
authors.affiliation: Department of Gastroenterology, Medical Centre for Postgraduate Education, Institute of Oncology, Warsaw, Poland. polek@coi.waw.pl
authors.forename: M
authors.initials: M
authors.lastname: Polkowski
authors.forename: J
authors.initials: J
authors.lastname: Regula
authors.forename: E
authors.initials: E
authors.lastname: Wronska
authors.forename: J
authors.initials: J
authors.lastname: Pachlewski
authors.forename: M
authors.initials: M
authors.lastname: Rupinski
authors.forename: E
authors.initials: E
authors.lastname: Butruk
mesh_terms: D000236:Adenoma / Q000098:blood supply / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery*; D003111:Colonic Polyps / Q000000981:diagnostic imaging* / Q000601:surgery*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies