title: Submucosal saline-epinephrine injection in colon polypectomy: appropriate indication.
abstract: OBJECTIVE
  Opinions vary among endoscopists concerning the indications for submucosal saline-epinephrine injection for the prevention of postpolypectomy complications after colonic snare polypectomy. This study was performed to determine the appropriate indications for submucosal saline-epinephrine injection.
  
  
  METHODS
  Clinical characteristics and complications (hemorrhage and perforation) in polypectomies were retrospectively evaluated. Postpolypectomy complications were analyzed in terms of demographic characteristics (age, gender), polyp characteristics (size, configuration, location, and histopathology), and the administration of submucosal saline-epinephrine injection.
  
  
  RESULTS
  Total 1039 polypectomies were performed in 563 patients (age 59.8 +/- 10.1 years), and submucosal saline-epinephrine injection was performed in 679 polypectomies. Twenty seven episodes (2.6%) of hemorrhage and 3 cases (0.2%) of perforation occurred. Malignant adenoma, a rectal polyp, and procedure without submucosal saline-epinephrine injection increased the risk of hemorrhage with odds ratios of 10.48, 4.71, and 3.44, respectively. Furthermore, submucosal saline-epinephrine injection significantly reduced the risk of hemorrhage in sessile polyps and those > 8 mm in size and with odds ratio of 16.41 regardless of location or histopathology. The occurrence of postpolypectomy perforation was not associated with any clinical characteristics and method.
  
  
  CONCLUSIONS
  Submucosal saline-epinephrine injection should be performed for sessile polyps and those > 8 mm in size, and might be performed optionally in other cases to prevent postpolypectomy hemorrhage.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital.
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Kyoung Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Jin-Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Sook-Hyang
authors.initials: SH
authors.lastname: Jung
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Lee
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Yoon
authors.forename: In Sung
authors.initials: IS
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000601:surgery*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D012965:Sodium Chloride / Q000008:administration & dosage*
chemical_list: D012965:Sodium Chloride; D004837:Epinephrine