Digestive Diseases and Sciences

, Volume 55, Issue 6, pp 1726–1731 | Cite as

Endoclip-Assisted Resection of Large Pedunculated Colorectal Polyps: Technical Aspects and Outcome

  • Carmelo Luigiano
  • Francesco Ferrara
  • Stefania Ghersi
  • Carlo Fabbri
  • Vincenzo Cennamo
  • Patrizia Landi
  • Anna Maria Polifemo
  • Paola Billi
  • Marco Bassi
  • Pierluigi Consolo
  • Angela Alibrandi
  • Nicola D’Imperio
Original Article

Abstract

Background

The most common complication of polypectomy is hemorrhage, and various techniques have been used to prevent this complication.

Aim

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Polypectomy Large pedunculated polyps Clip Loop Complications 

References

  1. 1.
    Winawer SJ, Zauber AG, O’Brien MJ, Ho MN, Gottlieb L, Sternberg SS, Waye JD, Bond J, Schapiro M, Stewart ET, Panish J, Ackroyd F, Kurtz RC, Shike M. Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med. 1993;328:901–906.CrossRefPubMedGoogle Scholar
  2. 2.
    Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF, Ackroyd F, Shike M, Kurtz RC, Hornsby-Lewis L, Gerdes H, Stewart ET. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med. 1993;329:1977–1981.CrossRefPubMedGoogle Scholar
  3. 3.
    Repici A, Tricerri R. Endoscopic polypectomy: techniques, complications and follow-up. Tech Coloproctol. 2004;8(Suppl 2):283–290.CrossRefGoogle Scholar
  4. 4.
    Rosen L, Bub DS, Reed JF 3rd, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum. 1993;36:1126–1131.CrossRefPubMedGoogle Scholar
  5. 5.
    Van Gossum A, Cozzoli A, Adler M, Taton G, Cremer M. Colonoscopic snare polypectomy: Analysis of 1485 resections comparing two types of current. Gastrointest Endosc. 1992;38:472–475.CrossRefPubMedGoogle Scholar
  6. 6.
    Dominitz JA, Eisen GM, Baron TH, Goldstein JL, Hirota WK, Jacobson BC, Johanson JF, Leighton JA, Mallery JS, Raddawi HM, Vargo JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J, Faigel DO; Standards of Practice Committee. American Society for Gastrointestinal Endoscopy. Complications of colonoscopy. Gastrointest Endosc. 2003;57:441–445.CrossRefPubMedGoogle Scholar
  7. 7.
    Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ. Postpolypectomy lower GI bleeding: Descriptive analysis. Gastrointest Endosc. 2000;51:690–696.CrossRefPubMedGoogle Scholar
  8. 8.
    Rohde H, Guenther MW, Budde R, Mühlhofer H. Randomized trial of prophylactic epinephrine-saline injection before snare polypectomy to prevent bleeding. Endoscopy. 2000;32:1004–1005.PubMedGoogle Scholar
  9. 9.
    Dobrowolski S, Dobosz M, Babicki A, Dymecki D, Hać S. Prophylactic submucosal saline–adrenaline injection in colonoscopic polypectomy: Prospective randomized study. Surg Endosc. 2004;18:990–993.CrossRefPubMedGoogle Scholar
  10. 10.
    Iishi H, Tatsuta M, Narahara H, Iseki K, Sakai N. Endoscopic resection of large pedunculated colorectal polyps using a detachable snare. Gastrointest Endosc. 1996;44:594–597.CrossRefPubMedGoogle Scholar
  11. 11.
    Di Giorgio P, De Luca L, Calcagno G, Rivellini G, Mandato M, De Luca B. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: A randomized and controlled study. Endoscopy. 2004;36:860–863.CrossRefPubMedGoogle Scholar
  12. 12.
    Paspatis GA, Paraskeva K, Theodoropoulou A, Mathou N, Vardas E, Oustamanolakis P, Chlouverakis G, Karagiannis I. A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. Am J Gastroenterol. 2006;101:2805–2809.CrossRefPubMedGoogle Scholar
  13. 13.
    Rey JF, Marek TA. Endo-loop in the prevention of the post-polypectomy bleeding: Preliminary results. Gastrointest Endosc. 1997;46:387–389.PubMedGoogle Scholar
  14. 14.
    Cariani G, Di Marco M, Roda E. Endoloop-assisted polypectomy for large peduncolated colorectal polyps. Surg Endosc. 2007;21:1676–1677.CrossRefPubMedGoogle Scholar
  15. 15.
    Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Chatzimavroudis G, Zavos C, Vasiliadis I, Katsinelos T, Papaziogas B. Endoloop-assisted polypectomy for large pedunculated colorectal polyps. Surg Endosc. 2006;20:1257–1261.CrossRefPubMedGoogle Scholar
  16. 16.
    Matsushita M, Hajiro K, Takakuwa H, Kusumi F, Maruo T, Ohana M, Tominaga M, Okano A, Yunoki Y. Ineffective use of a detachable snare for colonoscopic polypectomy of large polyps. Gastrointest Endosc. 1998;47:496–499.CrossRefPubMedGoogle Scholar
  17. 17.
    Iida Y, Miura S, Munemoto Y, Kasahara Y, Asada Y, Toya D, Fujisawa M. Endoscopic resection of large colorectal polyps using a clipping method. Dis Colon Rectum. 1994;37:179–180.CrossRefPubMedGoogle Scholar
  18. 18.
    Cipolletta L, Bianco MA, Rotondano G, Catalano M, Prisco A, De Simone T. Endoclip-assisted resection of large pedunculated colon polyps. Gastrointest Endosc. 1999;50:405–406.CrossRefPubMedGoogle Scholar
  19. 19.
    Katsinelos P, Chatzimavroudis G, Papaziogas B, Zavos C, Paroutoglou G, Pilpilidis I, Vasiliadis T, Kountouras J. Endoclipping-assisted resection of large colorectal polyps. Surg Laparosc Endosc Percutan Tech. 2008;18:19–23.CrossRefPubMedGoogle Scholar
  20. 20.
    Hamilton SR, Aaltonen LA. World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive system. Lyon: IARC Press; 2000, pp 103–143.Google Scholar
  21. 21.
    Binmoeller KF, Bohnacker S, Seifert H, Thonke F, Valdeyar H, Soehendra N. Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc. 1996;43:183–188.CrossRefPubMedGoogle Scholar
  22. 22.
    Stergiou N, Riphaus A, Lange P, Menke D, Köckerling F, Wehrmann T. Endoscopic snare resection of large colonic polyps: How far can we go? Int J Colorectal Dis. 2003;18:131–135.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Carmelo Luigiano
    • 1
  • Francesco Ferrara
    • 1
  • Stefania Ghersi
    • 1
  • Carlo Fabbri
    • 1
  • Vincenzo Cennamo
    • 2
  • Patrizia Landi
    • 1
  • Anna Maria Polifemo
    • 1
  • Paola Billi
    • 1
  • Marco Bassi
    • 1
  • Pierluigi Consolo
    • 3
  • Angela Alibrandi
    • 4
  • Nicola D’Imperio
    • 1
  1. 1.Unit of Gastroenterology and Digestive EndoscopyAUSL Bologna Bellaria-Maggiore HospitalBolognaItaly
  2. 2.Department of Internal Medicine and GastroenterologyUniversity of BolognaBolognaItaly
  3. 3.Department of Medicine and PharmacologyUniversity of MessinaMessinaItaly
  4. 4.Department of StatisticsUniversity of MessinaMessinaItaly

Personalised recommendations