Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8405
Peer-review started: September 3, 2017
First decision: September 20, 2017
Revised: October 3, 2017
Accepted: October 26, 2017
Article in press: October 26, 2017
Published online: December 21, 2017
Gastric and duodenal polypectomy is commonly performed. Although there is a theoretical increased risk of bleeding, there is scarce information regarding the potential adverse events (AEs) of polypectomy in this setting. The aim of this study was to evaluate the rate of AEs during consecutive gastric and duodenal polypectomies in several Spanish centers.
The safety of polypectomy in the upper GI tract is controversial because the reported rate in retrospective studies is higher than in colonic polypectomy but results come mainly from retrospective studies and they do not use the same standardized nomenclature and definitions for adverse events.
The aims of this study were to determine in a prospective study the rate of adverse events of gastroduodenal snare polypectomy for non-flat polyps; to evaluate the adverse events (early and late) that occur after a gastric and/or duodenal polypectomy as well as the predictive fractures for its development; to evaluate the different endoscopic techniques used in the prophylaxis of post-polypectomy hemorrhage.
The research methods: (1) Multicenter, longitudinal and prospective study of all patients undergoing polypectomy of gastric or duodenal polyps ≥ 5 mm using an electrocautery polypectomy snare; (2) Patients with PT < 50% and platelets < 50000 or clopidogrel in the 7 d prior to endoscopy were excluded; (3) Prophylactic measures of hemorrhage were allowed in certain predefined cases; (4) Intraprocedural hemorrhage was defined as bleeding that lasts more than 30 seconds and severity was graded from 1 to 4; (5) Late hemorrhage was defined as melena or hematochezia since discharge from endoscopy unit and up to 30 d. (6) Patients were followed during 30 d with serial phone calls; and (7) Predictive factors of complications were analyzed
308 patients were included and a single polypectomy was performed in 205. Hemorrhage prophylaxis was performed in 219 (71.1%) patients. Nine patients presented AEs (2.9%), and 6 of them were bleeding (n = 6, 1.9%) (In 5 out of 6 AEs, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.
The rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low. However, the number of bleeding episodes is not negligible and many of them receive prophylaxis or are treated endoscopically with injection, APC, hemostatic clips or a combination of methods which increases health care costs. Prophylactic measures do not reduce the risk of hemorrhage. To our knowledge, this is the first study using the ASGE lexicon for reporting adverse events of gastro-duodenal polypectomy and shows an acceptable low rate, confirming the safety of this procedure. Because AEs of gastroduodenal polypectomies are low, there is no need of using more than one prophylactic endoscopic technique (clips, sclerosis, APC…) with the consequent reduction of costs.
Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location. The future research direction is to compare the use of prophylaxis or not before polypectomy in gastric polyps and the best method would be a prospective, comparative and randomized study.