Endoclip-assisted resection of large pedunculated colorectal polyps: technical aspects and outcome.
BACKGROUND
The most common complication of polypectomy is hemorrhage, and various techniques have been used to prevent this complication.


OBJECTIVE
This study evaluates the outcomes of endoclip-assisted polypectomy in patients with large pedunculated colorectal polyps, in comparison with a historical control group of patients treated with endoloop-assisted polypectomy.


METHODS
Between January and December 2007, 32 patients with 32 large pedunculated polyps (>or=15 mm) were treated with endoclip-assisted polypectomy (group A). Between January and December 2006, 35 patients with 35 large pedunculated polyps were treated; 33 with endoloop-assisted polypectomy (control, group B) and two cases with endoclips and needle knife, which were included in group A for the analysis.


RESULTS
The mean (+/- standard deviation [SD]) size of polyp head was 26.8 +/- 8.1 mm (range 15-50) in group A and 22.3 +/- 4.1 mm (range 15-30) in group B (P = 0.004). In group A, six polyps had a mean (+/-SD) head size of 40.8 +/- 5.8 mm (range 35-50) and were resected with clips and needle knife. In group A, bleeding occurred in two cases (5.9%), which were associated with the presence of cancer at histology (P = 0.006) and were managed by applying new clips. No bleeding occurred in patients of group B and no perforation and post-polypectomy syndrome occurred in either group. There were three (8.8%) cancerized adenomas in group A and one (3%) in group B. Clip application was possible in all patients, while in two cases, loop placement was impossible.


CONCLUSIONS
In our experience, endoclip-assisted resection is a safe alternative to endoloop for the resection of large pedunculated colorectal polyps when endoloop placement is difficult or impossible.
Luigiano
Carmelo
C
Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy. carmeluigiano@libero.it
Ferrara
Francesco
F
Ghersi
Stefania
S
Fabbri
Carlo
C
Cennamo
Vincenzo
V
Landi
Patrizia
P
Polifemo
Anna Maria
AM
Billi
Paola
P
Bassi
Marco
M
Consolo
Pierluigi
P
Alibrandi
Angela
A
D'Imperio
Nicola
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D020685:Colonoscopes; D003113:Colonoscopy / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000473:pathology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome