Endoclip-Assisted Resection of Large Pedunculated Colorectal Polyps: Technical Aspects and Outcome
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- Luigiano, C., Ferrara, F., Ghersi, S. et al. Dig Dis Sci (2010) 55: 1726. doi:10.1007/s10620-009-0905-2
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The most common complication of polypectomy is hemorrhage, and various techniques have been used to prevent this complication.
This study evaluates the outcomes of endoclip-assisted polypectomy in patients with large pedunculated colorectal polyps, in comparison with a historical control group of patients treated with endoloop-assisted polypectomy.
Between January and December 2007, 32 patients with 32 large pedunculated polyps (≥15 mm) were treated with endoclip-assisted polypectomy (group A). Between January and December 2006, 35 patients with 35 large pedunculated polyps were treated; 33 with endoloop-assisted polypectomy (control, group B) and two cases with endoclips and needle knife, which were included in group A for the analysis.
The mean (± standard deviation [SD]) size of polyp head was 26.8 ± 8.1 mm (range 15–50) in group A and 22.3 ± 4.1 mm (range 15–30) in group B (P = 0.004). In group A, six polyps had a mean (±SD) head size of 40.8 ± 5.8 mm (range 35–50) and were resected with clips and needle knife. In group A, bleeding occurred in two cases (5.9%), which were associated with the presence of cancer at histology (P = 0.006) and were managed by applying new clips. No bleeding occurred in patients of group B and no perforation and post-polypectomy syndrome occurred in either group. There were three (8.8%) cancerized adenomas in group A and one (3%) in group B. Clip application was possible in all patients, while in two cases, loop placement was impossible.
In our experience, endoclip-assisted resection is a safe alternative to endoloop for the resection of large pedunculated colorectal polyps when endoloop placement is difficult or impossible.