Comparison of postpolypectomy bleeding between epinephrine and saline submucosal injection for large colon polyps by conventional polypectomy: a prospective randomized, multicenter study.
OBJECTIVE
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) were randomized 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.


CONCLUSIONS
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.
Lee
Suck-Ho
SH
Department of Internal Medicine, University of Soonchunhyang at Cheonan, Cheonan & Seoul & Bucheon, Republic of Korea. ygun99@hanmail.net
Chung
Il-Kwun
IK
Kim
Sun-Joo
SJ
Kim
Jin-Oh
JO
Ko
Bong-Min
BM
Kim
Won Ho
WH
Kim
Hyun-Soo
HS
Park
Dong-Il
DI
Kim
Hyo-Jong
HJ
Byeon
Jeong-Sik
JS
Yang
Suk-Kyun
SK
Jang
Byeong Ik
BI
Jung
Sung-Ae
SA
Jeen
Yoon-Tae
YT
Choi
Jai-Hyun
JH
Choi
Hwang
H
Han
Dong-Soo
DS
Song
Jae-Suk
JS
D000368:Aged; D003106:Colon / Q000473:pathology / Q000601:surgery; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007267:Injections; D007413:Intestinal Mucosa / Q000098:blood supply / Q000187:drug effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D004837:Epinephrine