Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jun 6:19:65-73.
doi: 10.1016/j.amsu.2017.05.035. eCollection 2017 Jul.

Efficacy of submucosal epinephrine injection for the prevention of postpolypectomy bleeding: A meta-analysis of randomized controlled studies

Thawatchai Tullavardhana  1 , Prinya Akranurakkul  1 , Withoon Ungkitphaiboon  1 , Dolrudee Songtish  1
Affiliations
Review

Efficacy of submucosal epinephrine injection for the prevention of postpolypectomy bleeding: A meta-analysis of randomized controlled studies

Thawatchai Tullavardhana et al. Ann Med Surg (Lond). .

Abstract

Background: Bleeding is the most common major complication following colonoscopic polypectomy. The purpose of this study is to evaluate whether submucosal epinephrine injections could prevent the occurrence of postpolypectomy bleeding.

Method: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for appropriate randomized controlled studies published before April 2015. A meta-analysis was conducted to investigate the preventative effect of submucosal epinephrine injection for overall, early, and delayed postpolypectomy bleeding.

Results: The final analysis examined the findings of six studies, with data from 1388 patients. The results demonstrated that prophylactic treatment with epinephrine injection significantly reduced the occurrence of overall (OR = 0.38, 95% CI: 0.21, 0.66; p = 0.0006) and early bleeding (OR = 0.38, 95% CI: 0.20, 0.69; p = 0.002). However, for delayed bleeding complications, epinephrine injections were not found to be any more effective than treatment with saline injection or no injection (OR = 0.45, 95% CI: 0.11, 1.81; p = 0.26). Moreover, for patients with polyps larger than 20 mm, mechanical hemostasis devices (endoloops or clips) were found to be more effective than epinephrine injection in preventing overall bleeding (OR = 0.33, 95% CI: 0.13, 0.87; p = 0.03) and early bleeding (OR = 0.29, 95% CI: 0.08, 1.02; p = 0.05). This was not established for delayed bleeding.

Conclusion: The routine use of prophylaxis submucosal epinephrine injection is safe and beneficial preventing postpolypectomy bleeding.

Keywords: Bleeding; Colonic polyp; Colonoscopic polypectomy; Epinephrine; Meta-analysis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study selection process.
Fig. 2
Fig. 2
Comparison of postpolypectomy bleeding in the epinephrine and control group.
Fig. 3
Fig. 3
Comparison of postpolypectomy bleeding in the mechanical and epinephrine group.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Winawer S.J., Zauber A.G., Ho M.N., O'Brien M.J., Gottlieb L.S., Sternberg S.S. Prevention of colorectal cancer by colonoscopic polypectomy. The national polyp study workgroup. N. Engl. J. Med. 1993;329(27):1977–1981. - PubMed
    1. Rogers B.H., Silvis S.E., Nebel O.T., Sugawa C., Mandelstam P. Complications of flexible fiberoptic colonoscopy and polypectomy. Gastrointest. Endosc. 1975;22(2):73–77. - PubMed
    1. Rosen L., Bub D.S., Reed J.F., 3rd, Nastasee S.A. Hemorrhage following colonoscopic polypectomy. Dis. colon rectum. 1993;36(12):1126–1131. - PubMed
    1. Choo W.K., Subhani J. Complication rates of colonic polypectomy in relation to polyp characteristics and techniques: a district hospital experience. J. interv. gastroenterol. 2012;2(1):8–11. - PMC - PubMed
    1. Kim H.S., Kim T.I., Kim W.H., Kim Y.H., Kim H.J., Yang S.K., Myung S.J., Byeon J.S., Lee M.S., Chung I.K., Jung S.A., Jeen Y.T., Choi J.H., Choi K.Y., Choi H., Han D.S., Song J.S. Risk factors for immediate postpolypectomy bleeding of the colon: a multicenter study. Am. J. gastroenterol. 2006;101(6):1333–1341. - PubMed