Prophylactic submucosal saline-adrenaline injection in colonoscopic polypectomy: prospective randomized study.
BACKGROUND
Endoscopic polypectomy is a standard method of treatment of gastrointestinal polyps, but is associated with substantial risk of complications. The most common is hemorrhage, the rate of which varied between 0.3%, and 6%. Various prophylactic techniques have been used to reduce this incidence. The aim of this study was to establish whether the prophylactic injection of adrenaline-saline solution reduces the risk of postpolypectomy bleeding in colonoscopic polypectomy.


METHODS
Between May 2000 and June 2002, patients with colorectal polyps of size > or =1 cm were randomized to receive submucosal epinephrine injection (group A) or no injection (group B). The polypectomies were carried out using the conventional method. In group A, epinephrine (1/10,000) was injected into the stalk or base of the polyp. The patients were observed for complications.


RESULTS
A total of 69 patients with 100 polyps were enrolled in this study: n = 50 in group A, and n = 50 in group B, according to randomization. There were a total of nine episodes of postpolypectomy hemorrhage, one in the epinephrine group and eight in the control group (1/50 vs 8/50, p < 0.05). The bleeding correlated with the size of the polyps and the diameter of the stalks.


CONCLUSIONS
Epinephrine injection prior to colonoscopic polypectomy is effective in preventing bleeding.
Dobrowolski
S
S
Department of General, Gastroenterological and Endocrinological Surgery, Medical University of Gdansk, Ul. Kieturakisa 1, 80-742, Gdansk, Poland. sdob@wp.pl
Dobosz
M
M
Babicki
A
A
Dymecki
D
D
Hać
S
S
D000230:Adenocarcinoma / Q000098:blood supply / Q000601:surgery*; D018256:Adenomatous Polyps / Q000098:blood supply / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D003110:Colonic Neoplasms / Q000098:blood supply / Q000601:surgery*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000379:methods*; D004564:Electrocoagulation; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011292:Premedication; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000098:blood supply / Q000601:surgery; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use
D006490:Hemostatics; D012965:Sodium Chloride; D004837:Epinephrine