Colonic Polyp
Conditions
Keywords
Colonic Polyp, Endoscopic mucosal resection
Brief summary
Bleeding is the most common complication associated with polypectomy of large pedunculated colonic polyp. Although several techniques have been developed to minimize bleeding, none of these methods has become the gold standard. To prevent post-polypectomy bleeding effectively, the investigators developed and attempted a new endoscopic technique for removal of large long-stalked pedunculated colonic polyps using band ligations. This study aims to evaluate the safety and efficacy of a novel technique using endoscopic band ligation for removal of long-stalked pedunculated colon polyps.
Detailed description
A prospective single-center study was conducted. Targeted polyps were large (head size \>10 mm) with long stalk length (\>10 mm) in the distal colon. After finding target lesions by standard colonoscopy, conventional upper endoscopy with rubber band (endoscopic band ligation, EBL) was applied to squeeze the mid-portion of the stalk to form an omega shape, which had the dual effect of ligation and compression of feeding blood vessels. After strangulation of the stalk, snare polypectomy was performed at the stalk site just above the ligation. The investigators evaluated several parameters, including completeness of resection, procedure time, and complications, including immediate postpolypectomy bleeding, delayed postpolypectomy bleeding, and perforation.
Interventions
DEVICEEndoscopic band ligation assisted polypectomy
A conventional upper endoscope loaded with a band ligator was inserted in the colon and was advanced to the site of the pedunculated polyp. After approaching the lateral side of the stalk and grasping the mid-portion of the stalk using a tripod grasper. Then, the rubber band was released from the cap to ligate the stalk. Thereafter, we performed polypectomy of the remaining stalk just above the ligation by extending the electrosurgical snare.
Sponsors
Uijeongbu St. Mary Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Polyps with head \>10 mm and stalk length \>10 mm; * Location at the distal segments of the colon; and * Benign features under endoscopic inspection (absence of ulceration and induration or friability).
Exclusion criteria
* Patients who refuse to sign the consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Procedure time | during the procedure | From approaching the the stalk to snare polypectomy with electrosurgical snare |
| Rate of immediate postpolypectomy bleeding | during the procedure | pulsating bleeding or oozing lasting more than 60 s immediately after polypectomy or requiring endoscopic intervention. |
| Rate of delayed postpolypectomy bleeding | 30 days after procedure | gross rectal bleeding, bleeding requiring endoscopic or radiological hemostasis, or transfusions requiring surgery |
| Rate of completed polyp resection | Immediately after the intervention | a lesion-free margin with both the lateral and basal tissues free of pathology |
| Rate of perforation | 30 days after procedure | endoscopically observed colonic wall penetration, or perforation detected after endoscopy by radiological examination including abdomen CT. |
Outcome results
None listed