Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: A randomized and controlled study

Background and Study Aims: Several endoscopic techniques have been developed to prevent bleeding after the removal of large pedunculated polyps. Patients and Methods: From January 1995 to December 2002, 488 consecutive patients with pedunculated colorectal polyps, the heads of which were larger than 10 mm in diameter, were randomly assigned to three groups. In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used for polypectomy. In group B (161 patients), the polyp stalk was injected with a 0.01 % epinephrine solution before conventional snare polypectomy. Group C (a control group including 164 patients) underwent conventional snare polypectomy without preventive measures. Early (< 24 h) and late (>24h-30 days) bleeding complications were assessed. Each group was divided into two subgroups relative to the polyp size (polyps 1.0 - 1.9 cm and polyps greater than or equal to 2 cm). Results: Overall bleeding complications occurred after 4.3% of the polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8%), five in group B (3.1 %), and 13 in group C (7.9 %). Early bleeding was more frequent than late bleeding (15 vs. six patients). In polyps ! 2 cm (207 patients), postpolypectomy bleeding occurred in 14 patients (6.7%): two (2.7%) in the detachable snare group, two (2.9%) in the epinephrine injection group, and 10 (15.1 %) in the control group. Conclusions: These results show that polypectomy of large pedunculated polyps is associated with a higher incidence of bleeding. Particularly in polyps larger than 2 cm, preventive measures can significantly reduce bleeding complications after polypectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine.