title: Comparison of postpolypectomy bleeding between epinephrine and saline submucosal injection for large colon polyps by conventional polypectomy: a prospective randomized, multicenter study.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University of Soonchunhyang at Cheonan, Cheonan & Seoul & Bucheon, Republic of Korea. ygun99@hanmail.net
authors.forename: Suck-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Il-Kwun
authors.initials: IK
authors.lastname: Chung
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jin-Oh
authors.initials: JO
authors.lastname: Kim
authors.forename: Bong-Min
authors.initials: BM
authors.lastname: Ko
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Hyun-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Park
authors.forename: Hyo-Jong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Suk-Kyun
authors.initials: SK
authors.lastname: Yang
authors.forename: Byeong Ik
authors.initials: BI
authors.lastname: Jang
authors.forename: Sung-Ae
authors.initials: SA
authors.lastname: Jung
authors.forename: Yoon-Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Jai-Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Hwang
authors.initials: H
authors.lastname: Choi
authors.forename: Dong-Soo
authors.initials: DS
authors.lastname: Han
authors.forename: Jae-Suk
authors.initials: JS
authors.lastname: Song
mesh_terms: 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*
chemical_list: D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D004837:Epinephrine