Antonio Facciorusso, MD, from the Gastroenterology Unit, Department of Medical Sciences, at the University of Foggia in Foggia, Italy discusses this Original Article, “Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis.”
Endoscopic mucosal resection (EMR) is frequently used for polyps over 20 mm in diameter. The technique involves the injection of fluid into the submucosal space to expand it, rendering polypectomy easier and safer (“inject-and-cut” technique). The major drawbacks of EMR are post-polypectomy adverse events, such as bleeding and perforation. The submucosal epinephrine-saline solution injection is commonly used, although the real efficacy of such a procedure is still a matter of debate.
The aim of our study was to compare the efficacy and safety profile of submucosal polidocanol injection with respect to epinephrine-saline injection for endoscopic resection of large (i.e. ≥ 20 mm) sessile colon polyps. The primary endpoint was the prevention of post-polypectomy bleeding (PPB). Secondary objectives were the prevention of post-procedural perforation, en bloc resection rate, procedural time, successful single-session complete removal of the lesion and recurrent/residual adenoma rate at 3 months. To the best of our knowledge, our study represents the first report on the efficacy of sclerosing agent (specifically polidocanol) injection in the endoscopic resection of colon polyps.
Our propensity score matching analysis performed on 2 large consecutive cohorts of patients (612 overall) found a significantly lower rate of both immediate and delayed bleeding in the polidocanol group (3.9% vs 10.7%, P=.001 and 1.3% vs 6.2%, P=.002, respectively). The type of injection used and the size of the polyp were the only prognostic factors at the multivariate analysis for PPB, either immediate and delayed.
Superiority of polidocanol was confirmed in all the subgroups of patients. Other post-procedural adverse events were similar between the 2 groups and in keeping with published literature.
Despite not reaching the statistical significance, polidocanol injection shortened the procedure duration and lowered the number of snare resection per lesion and the solution volume needed to infiltrate the polyps (Table 2).
In conclusion, the large number of patients, the completeness of the collected data, and the robust statistical approach strengthen the results of our analysis which paves the way to the use of sclerosing agents in colon polypectomy.
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