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

Korean J Gastrointest Endosc > Volume 33(2); 2006 > Article

Korean Journal of Gastrointestinal Endoscopy 2006;33(2): 77-84.

대장 내시경하 폴립절제술에서 점막하 식염수-에피네프린 주입술의 적절한 적용 기준은 무엇인가?

이상협·이경수·우열근·예병덕·이종열·박수철·이광혁*·박영수*·황진혁*·정숙향*·김나영*·이동호*·김상균·김주성·정현채·송인성

서울대학교 의과대학 내과학교실, 간연구소, *분당서울대학교병원 내과

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

Sang Huyb Lee, M.D., Kyoung Soo Lee, M.D., Yeol Keun Woo, M.D., Byong Duk Ye, M.D., Jong Yeul Lee, M.D., Su Cheol Park, M.D., Kwang Hyuck Lee, M.D.*, Young Soo Park, M.D.*, Jin-Hyeok Hwang, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M.D.*, Dong Ho Lee, M

Liver Research Institute and Department of Internal Medicine, Seoul National University College of Medicine, Seoul, *Department of Internal Medicine, Seoul National University Bungdang Hospital, Seongnam, Korea

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 (≤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. (Korean J Gastrointest Endosc 2006;33:77⁣84)

Key Words: Polypectomy, Complications, Submucosal Injection

주요어: 폴립절제술, 합병증, 점막하 주입술