Clin Endosc.  2012 Mar;45(1):84-88. 10.5946/ce.2012.45.1.84.

Clipping for the Prevention of Immediate Bleeding after Polypectomy of Pedunculated Polyps: A Pilot Study

• Boo SJ
• Byeon JS
• Park SY
• Rew JS
• Lee DM
• Shin SJ
• Kim DU
• Song GA

• KMID: 2048837
• DOI: http://doi.org/10.5946/ce.2012.45.1.84

Abstract

BACKGROUND/AIMS
Immediate postpolypectomy bleeding (IPPB) increases the procedure time and it may disturb performing a safe polypectomy. The purpose of this study is to investigate whether clipping before snare polypectomy of large pedunculated polyps is useful for the prevention of IPPB.
METHODS
This is a single arm, pilot study. We enrolled patients with pedunculated colorectal polyps that were 1 cm in size or more from 4 university hospitals between June 2009 and June 2010. Clips were applied at the stalk and snare polypectomy was then performed. The complications, including IPPB, were investigated.
RESULTS
Fifty six pedunculated polyps in 47 patients (Male:Female=36:11; age, 56+/-11 years) were included. The size of the polyp heads was 17+/-8 mm. Tubular adenoma was most common (57%). The number of clips used before snare polypectomy was 2+/-0.5. The procedure was successful in all cases. IPPB occurred in 2 cases (3.6%), and both of these were managed by additional clipping. Delayed bleeding occurred in another one case (1.8%), which improved with conservative treatment. No perforation occurred.
CONCLUSIONS
We suggest that clipping before snare polypectomy of pedunculated polyps may be an easy and effective technique for the prevention of IPPB, and this should be confirmed in large scale, prospective, controlled studies.

Keyword

Pedunculated polyp; Polypectomy; Clip; Bleeding

MeSH Terms

Adenoma
Arm
Head
Hemorrhage
Hospitals, University
Humans
Intermittent Positive-Pressure Breathing
Pilot Projects
Polyps
SNARE Proteins
SNARE Proteins

Figure

• 

  Fig. 1 Endoscopic snare polypectomy of a pedunculated polyp after clipping. (A) An about 20 mm sized, pedunculated polyp is seen. (B) The stalk was tightened completely by 2 clips. (C) A snare is being placed between the polyp head and clips. (D) Cutting of the stalk by snare polypectomy resulted in the clear cut surface without any evidence of immediate bleeding.

• 

  Fig. 2 Endoscopic snare polypectomy after clipping in another case. (A) An about 20 mm sized polyp with a thick stalk is seen. (B) The stalk was tightened by a clip. (C) Snaring was performed after the placement of 2 clips. (D) The clear cut surface without any evidence of immediate bleeding is seen after cutting of the stalk by snare polypectomy.

• 

  Fig. 3 Endoscopic snare polypectomy after clipping of a short thick stalk. (A) An about 20 mm sized polyp with a short thick stalk is seen. (B) The stalk was tightened by 2 clips. (C) Snaring was performed successfully. (D) No immediate bleeding occurred after snare polypectomy.

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