Polypectomy: Looking back

Gastrointestinal Endoscopy (Impact Factor: 5.37). 01/2005; 60(6):977-82. DOI: 10.1016/S0016-5107(04)02380-6
Source: PubMed
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    • "The method was performed and reported in 1969 by Shinya Hiromi et al. for the first time. It is the oldest and the most commonly performed method, and it has been applied to remove sessile polyps 0.5-1 cm in size or pedunculated polyps larger than 1 cm in size [7, 8]. Among the oval type, crescent type, hexagonal type, spike type and other various types of snares, we have performed the hot snaring method with the oval type; after the injection of normal saline, polyps were snared and then galvanized using cutting currents. "
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    ABSTRACT: The colonoscopic polypectomy has become a valuable procedure for removing precursors of colorectal cancer, but some complications can be occurred. The most common complication after colonoscopic polypectomy is bleeding, which is reported to range from 1% to 6% and which can be immediate or delayed. Because the management of delayed postpolypectomy bleeding could be difficult, the use of preventive technique and reductions of risk factors are essential. From January 2007 to December 2008, delayed hemorrhage occurred in 18 of the 1,841 polypectomy patients examined by one endoscopist. These cases were reviewed retrospectively for risk factors, pathologic findings, and treatment methods. Delayed bleeding occurred in 18/1,841 patients (0.95%). The mean age was 55.9 ± 10.9 years, and the male-to-female ratio was 8:1. The most common site was the right colon (11 cases, 61.1%), and the average polyp size was 9.2 ± 2.8 mm. Delayed bleeding was identified from 1 to 5 days after resection (mean, 1.6 ± 1.2 days). The most common macroscopic type of polyp was a sessile polyp (10 cases, 55.6%), and histologic finding was a tubular adenoma in 13 cases (72.2%). Seventeen cases were treated with clipping for hemostasis and 1 case with epinephrine injection. The right colon and a sessile polyp were associated with an increase in delayed postpolypectomy bleeding. Reducing risk factors and close observation were essential in high risk patients, and prompt management with hemoclips was effective.
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