title: Endoclip-assisted resection of large pedunculated colorectal polyps: technical aspects and outcome.
abstract: 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.
authors: Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy. carmeluigiano@libero.it
authors: Carmelo
authors: C
authors: Luigiano
authors: Francesco
authors: F
authors: Ferrara
authors: Stefania
authors: S
authors: Ghersi
authors: Carlo
authors: C
authors: Fabbri
authors: Vincenzo
authors: V
authors: Cennamo
authors: Patrizia
authors: P
authors: Landi
authors: Anna Maria
authors: AM
authors: Polifemo
authors: Paola
authors: P
authors: Billi
authors: Marco
authors: M
authors: Bassi
authors: Pierluigi
authors: P
authors: Consolo
authors: Angela
authors: A
authors: Alibrandi
authors: Nicola
authors: N
authors: D'Imperio
mesh_terms: 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