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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

OBJECTIVES:Our study sought to compare the efficacy of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps.METHODS:At the time of colonoscopy, patients with at least one colonic polyp ≥2 cm were randomized to receive treatment either by the injection of a 1:10.000 solution of adrenaline and the position of a detachable snare followed by a conventional snare polypectomy (group A) or injection of adrenaline followed by a conventional snare polypectomy (group B). A total of 159 consecutive patients were randomly assigned to one of the above groups. Out of them, 84 patients (47 men, 37 women, mean age 61 yr) were assigned to group A and 75 (37 men, 38 women, mean age 64 yr) to group B. Early (<24 h) and late (>24 h–30 days) bleeding complications were assessed.RESULTS:Overall bleeding complications occurred in 10/159 (6.2%) of the patients. There were two cases of bleeding in group A (2.3%), and eight in group B (10.6%) (P = 0.04). The number of early bleeding episodes was significantly reduced in group A patients (1 case) compared to that of group B (7 cases) (P = 0.02). In contrast, there was no significant difference between group A and B as far as late bleeding is concerned.CONCLUSIONS:Our data suggest that the use of adrenaline injection in combination with detachable snare may significantly decrease the number of early postpolypectomy bleeding episodes in patients with large colonic polyps.