Large polyps: strangle or blanch them, but do something ▸

Bleeding is not uncommon after polypectomy, yet strategies for minimising bleeding risk are unclear and comparative studies of different methods are few and far between. The authors randomised 488 patients undergoing removal of pedunculated polyps to either placement of a detachable nylon snare (Endoloop), injection of 0.01% epinephrine into the stalk before polypectomy, or snare polypectomy alone (control group). All patients were hospitalised for 24 hours to monitor for early bleeding and followed for 30 days to detect delayed bleeding. Twenty one patients (4.3%) had bleeding and the mean size of bleeding polyps was 29.7 (4) mm, with early bleeding accounting for 15 of these cases. Bleeding episodes were more common in the control group (13) compared with three in the Endoloop group and five in the epinephrine group but this was not statistically significant. When subanalysed however, both Endoloop (2 (2.7%)) and epinephrine injection (2 (2.9%)) significantly reduced bleeding from polyps >2 cm compared with the control group (66 (15.1%)), and both treatment modalities were equally effective. While no substitute for careful patient selection, recognition of lesions at high risk and …