Stalk Injection and Prophylactic Clipping of Pedunculated Polyps Increase Delayed Bleeding
Douglas K. Rex, MD, MASGE, reviewing Tagawa T, et al. Gastrointest Endosc 2021 Apr 12.
In this Japanese study from 5 institutions, 1147 pedunculated (stalk length of ≥5 mm) colorectal polyps were evaluated for predictors of immediate bleeding after being removed by Endo Cut (Erbe Elektromedizin GmbH, Tuebingen, Germany) or forced coagulation current. Overall, immediate bleeding occurred in 8.5% of polypectomies, and the all-important delayed bleeding occurred in 2% of polypectomies. For polyps ≥15 mm in size, Endoloop (Ethicon, Somerville, NJ) reduced the risk of immediate bleeding by 83% but did not prevent delayed bleeding. Prophylactic clipping before polypectomy (odds ratio [OR], 4.2) and injecting the stalk (OR, 4.0) actually increased the risk of delayed bleeding. Placement of clips on the resection site after polyp removal was not associated with a reduced risk of delayed bleeding.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Tagawa T, Yamada M, Minagawa T, et al. Endoscopic characteristics influencing postpolypectomy bleeding in consecutive 1147 pedunculated colonic polyps: a multicenter retrospective study. Gastrointest Endosc 2021 Apr 12. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.03.996)