Background and Aims: The most common complication of polypectomy is haemorrhage, specially for removal of large pedunculated polyps with a large artery in the stalk. Various prophylactic techniques have been used to prevent this complication. Aim of the study was to assess the efficacy, safety and complication rate applying endoclips to the stalk before resection of large pedunculated colorectal polyps. Patients and Methods: This prospective study included 34 patients (26M and 8F, mean age 68.3 ± 10.2 years (range 45-85)) with 34 large pedunculated colorectal polyps, who underwent endoclip-assisted resection between November 2006 and December 2007. The outcome of the technique and the technique-related complications were evaluated. Statistical analysis was performed with Log-Likelihood and Spearman test. Results: Endoclip application and en bloc resection of polyps was possible in all patients. Mean diameter of the stalk was 8.1 ± 3.2 mm (range 5-15). The mean polyp head size was 26.8 ± 8.1 mm (range 15-50) and the larger diameters of polyp head were related to older age of patients (P=0.007). Six (17.6%) polyps had a mean head size of 40.8 ± 5.8 mm (range 35-50) and were resected with clips and needle-knife papillotome. The most frequent location of the polyps was sigmoid colon in 22/34 (64.8%). The most frequent histological type was villous adenoma (12/34, 35.3%). The most frequent degree of dysplasia was low (50%) and there were 3 (8.8%) adenomas containing cancer. Bleeding occurred in 2 cases (5.9%), associated to presence of cancer (P=0.006), and was endoscopically managed applying new clips. No perforation or post-polypectomy syndrome occurred. Mean number of clips utilized was 2.2 ± 1.1 (range 1-5) and the number of clips utilized was related to head size (P <0.001) and stalk size (P <0.001). Conclusions: Actually endo-loop is the most used prophylactic technique for the resection of large pedunculated polyps, but the application may be difficult or in same cases impossible (e.g. in narrow sigmoid colon or for polyps with a large head). Another method, for very large polyps, is piecemeal resection but there are increased risks of bleeding and inadequate tissue sampling. The other possibility is endoclip-assisted resection; in our experience this is an efficacy and safe procedure, with low risks of complication and with the advantage that also very large polyps, with needle knife, can be resected en-bloc (so that presence or absence of carcinoma can be determined with precision and unnecessary surgery avoided).
Luigiano, C., Ferrara, F., Ghersi, S., Cennamo, V., Billi, P., Fabbri, C., et al. (2009). Efficacy, Safety and Complications of Endoclip-Assisted Resection of Large Pedunculated Colorectal Polyps. GASTROINTESTINAL ENDOSCOPY, 69(5), AB322-AB322 [10.1016/j.gie.2009.03.918].
Efficacy, Safety and Complications of Endoclip-Assisted Resection of Large Pedunculated Colorectal Polyps
Billi, P;Fabbri, C;
2009
Abstract
Background and Aims: The most common complication of polypectomy is haemorrhage, specially for removal of large pedunculated polyps with a large artery in the stalk. Various prophylactic techniques have been used to prevent this complication. Aim of the study was to assess the efficacy, safety and complication rate applying endoclips to the stalk before resection of large pedunculated colorectal polyps. Patients and Methods: This prospective study included 34 patients (26M and 8F, mean age 68.3 ± 10.2 years (range 45-85)) with 34 large pedunculated colorectal polyps, who underwent endoclip-assisted resection between November 2006 and December 2007. The outcome of the technique and the technique-related complications were evaluated. Statistical analysis was performed with Log-Likelihood and Spearman test. Results: Endoclip application and en bloc resection of polyps was possible in all patients. Mean diameter of the stalk was 8.1 ± 3.2 mm (range 5-15). The mean polyp head size was 26.8 ± 8.1 mm (range 15-50) and the larger diameters of polyp head were related to older age of patients (P=0.007). Six (17.6%) polyps had a mean head size of 40.8 ± 5.8 mm (range 35-50) and were resected with clips and needle-knife papillotome. The most frequent location of the polyps was sigmoid colon in 22/34 (64.8%). The most frequent histological type was villous adenoma (12/34, 35.3%). The most frequent degree of dysplasia was low (50%) and there were 3 (8.8%) adenomas containing cancer. Bleeding occurred in 2 cases (5.9%), associated to presence of cancer (P=0.006), and was endoscopically managed applying new clips. No perforation or post-polypectomy syndrome occurred. Mean number of clips utilized was 2.2 ± 1.1 (range 1-5) and the number of clips utilized was related to head size (P <0.001) and stalk size (P <0.001). Conclusions: Actually endo-loop is the most used prophylactic technique for the resection of large pedunculated polyps, but the application may be difficult or in same cases impossible (e.g. in narrow sigmoid colon or for polyps with a large head). Another method, for very large polyps, is piecemeal resection but there are increased risks of bleeding and inadequate tissue sampling. The other possibility is endoclip-assisted resection; in our experience this is an efficacy and safe procedure, with low risks of complication and with the advantage that also very large polyps, with needle knife, can be resected en-bloc (so that presence or absence of carcinoma can be determined with precision and unnecessary surgery avoided).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
