Submucosal Saline-Epinephrine Injection in Colonoscopic Polypectomy: What is the Proper Application?

Lee, Sang Huyb; Lee, Kyoung Soo; Woo, Yeol Keun; Ye, Byong Duk; Lee, Jong Yeul; Park, Su Cheol; Lee, Kwang Hyuck; Park, Young Soo; Hwang, Jin Hyeok; Jung, Sook Hyang; Kim, Nayoung; Lee, Dong Ho; Kim, Sang Gyun; Kim, Joo Sung; Jung, Hyun Chae; Song, In Sung

Abstract

BACKGROUND/AIMS: Indications for submucosal saline-epinephrine injection (SSEI) for prevention of postpolypectomy bleeding, in the colon, is variable among endoscopists. The aim of this study was to determine the proper indication for SSEI.
METHODS
Clinical data of 1,745 polypectomies was evaluated. Postpolypectomy bleeding after snare polypectomy were evaluated in 1,039 polypectomies. Subgroup analysis was performed in 4 subgroups by size (< or = 8 mm or >8 mm) and gross morphology (pedunculated or sessile), also.
RESULTS
Submucosal saline-epinephrine injection was used in 679 snare polypectomies. The size of polyps was 9.5+/-4.3 mm. Distribution of polyps showed left side shift in the colon. Sessile polyps (79.4%) and benign adenoma (75.3%) were predominant. Twenty seven episodes (2.6%) of bleeding occurred after snare polypectomy. Rectal polyp, malignant polyp and procedure without SSEI increased bleeding after snare polypectomy with odds ratio 4.71, 10.48 and 3.44, respectively. However, SSEI significantly reduced the bleeding only in patients who had >8 mm sized sessile polyps with odds ratio 16.41 regardless of location and histopathology.
CONCLUSIONS
SSEI should be performed in colonoscopic snare polypectomy for >8 mm sized sessile polyps, and might be performed in others for prevention of bleeding at the discretion of the clinician.