title: Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis.
abstract: BACKGROUND
  EMR is the standard of care for the resection of large polyps.
  
  
  OBJECTIVE
  To compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare.
  
  
  METHODS
  After 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection.
  
  
  METHODS
  Endoscopic suite at the University of Foggia between 2005 and 2014.
  
  
  METHODS
  Of 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching.
  
  
  METHODS
  Submucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients.
  
  
  METHODS
  Univariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB).
  
  
  RESULTS
  The 2 groups presented similar baseline clinical parameters and lesion characteristics. All patients had a single polyp 20 mm or larger; the median size was 32 mm (interquartile range [IQR], 25-38) in the polidocanol group and 32 (IQR, 24-38) in the epinephrine group (P=.7). Polidocanol was more effective in preventing both immediate and delayed PPB (P<.001 and P=.003, respectively), and its efficacy was confirmed in almost all of the subgroups, regardless of polyp size and histology. Postprocedure perforation was observed in 2 patients (0.3%), both in the epinephrine group (P=.49). The 2 groups did not differ in the number of snare resections of lesions or the procedure duration (P=.24 and .6, respectively).
  
  
  CONCLUSIONS
  Absence of randomization.
  
  
  CONCLUSIONS
  The submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate.
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Facciorusso
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Di Maso
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Antonino
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Del Prete
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Panella
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Barone
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Muscatiello
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003111:Colonic Polyps / Q000601:surgery; D003113:Colonoscopy; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D007267:Injections; D007416:Intestinal Perforation / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D057216:Propensity Score; D012189:Retrospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D012597:Sclerosing Solutions; D014662:Vasoconstrictor Agents; D000077423:Polidocanol; D011092:Polyethylene Glycols; D004837:Epinephrine