BACKGROUND: Endoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter presents a risk of bleeding. To minimize this complication, we performed endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation and evaluated its safety and effectiveness. METHODS: Seventeen patients with 20 pedunculated or semipedunculated polyps with heads 1 cm or greater in diameter were treated with this technique. Conventional upper-GI endoscope, hypertonic saline-solution and epinephrine, sclerotherapy needle, and endoscopic band ligator device are needed for the procedure. OBSERVATIONS: All lesions were easily and safely resected. During this procedure, a band ligation chamber proved to be satisfactory for accurate recognition of a postpolypectomy ulcer under good visual control. No hemorrhage, perforation, or other complication occurred as a result of the use of this technique. The histologic resection margin was affected by nonneoplastic components in 6 of 20 lesions. Follow-up endoscopy 1 week later revealed a small, shallow ulcer without residual polyp in all lesions. CONCLUSIONS: This preliminary study suggests that endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation is a simple and effective method for the prevention of polypectomy-associated bleeding. Prospective trials, including randomized controlled studies, are required to evaluate the suitability of this modality for wide clinical use.
BACKGROUND: Endoscopic resection of pedunculated polyps with heads 1 cm or greater in diameter presents a risk of bleeding. To minimize this complication, we performed endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation and evaluated its safety and effectiveness. METHODS: Seventeen patients with 20 pedunculated or semipedunculated polyps with heads 1 cm or greater in diameter were treated with this technique. Conventional upper-GI endoscope, hypertonic saline-solution and epinephrine, sclerotherapy needle, and endoscopic band ligator device are needed for the procedure. OBSERVATIONS: All lesions were easily and safely resected. During this procedure, a band ligation chamber proved to be satisfactory for accurate recognition of a postpolypectomy ulcer under good visual control. No hemorrhage, perforation, or other complication occurred as a result of the use of this technique. The histologic resection margin was affected by nonneoplastic components in 6 of 20 lesions. Follow-up endoscopy 1 week later revealed a small, shallow ulcer without residual polyp in all lesions. CONCLUSIONS: This preliminary study suggests that endoscopic resection with hypertonic saline-solution-epinephrine injection plus band ligation is a simple and effective method for the prevention of polypectomy-associated bleeding. Prospective trials, including randomized controlled studies, are required to evaluate the suitability of this modality for wide clinical use.
Authors: Hyun Ho Choi; Chang Whan Kim; Hyung-Keun Kim; Sang Woo Kim; Sok Won Han; Kyung Jin Seo; Hiun-Suk Chae Journal: Saudi J Gastroenterol Date: 2021 Sep-Oct Impact factor: 2.485