Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis

Abstract

Background: EMR is the standard of care for the resection of large polyps.

Objective: To compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare.

Design: After 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection.

Setting: Endoscopic suite at the University of Foggia between 2005 and 2014.

Patients: Of 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching.

Interventions: Submucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients.

Main outcome measurements: Univariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB).

Results: The 2 groups presented similar baseline clinical parameters and lesion characteristics. All patients had a single polyp 20 mm or larger; the median size was 32 mm (interquartile range [IQR], 25-38) in the polidocanol group and 32 (IQR, 24-38) in the epinephrine group (P=.7). Polidocanol was more effective in preventing both immediate and delayed PPB (P<.001 and P=.003, respectively), and its efficacy was confirmed in almost all of the subgroups, regardless of polyp size and histology. Postprocedure perforation was observed in 2 patients (0.3%), both in the epinephrine group (P=.49). The 2 groups did not differ in the number of snare resections of lesions or the procedure duration (P=.24 and .6, respectively).

Limitations: Absence of randomization.

Conclusion: The submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate.