Epinephrine volume reduction of giant colon polyps facilitates endoscopic assessment and removal

BackgroundManagement of giant colon polyps (>3 cm) can be a challenge for the therapeutic endoscopist, especially the endoscopist in training. Challenges include the potential for bleeding and the difficult technical aspects of removing giant polyps. Years of clinically observing the effects of epinephrine injection to reduce bleeding revealed epinephrine's pronounced volume-reducing effect. This epinephrine volume reduction (EVR) greatly facilitates assessment and removal of giant polyps while decreasing the need for piecemeal resection.ObjectiveOur purpose was to demonstrate the use of EVR in facilitating the evaluation and removal of giant colon polyps.DesignCase reports defining the technique of EVR.SettingBusy ambulatory endoscopy center with more than 22,000 cases in 2006.PatientsGeneral population of patients treated in this ambulatory endoscopy center for giant colon polyps.InterventionsEVR and polypectomy.Outcome MeasurementsPre-EVR and post-EVR volumes in giant polyps. Relative ease of removal of pre-EVR versus post-EVR polyp and observations for complications.ResultsTypically greater than 80% reduction in polyp volume was achieved, greatly easing endoscopic evaluation and removal while virtually eliminating the need for piecemeal resection. EVR was associated with no acute or delayed bleeding complications.LimitationsMay be limited by inexperienced endoscopist's lack of injection and polypectomy skills. The technical difficulty in objective measurements of in vivo size and lack of blinded observations with a control group present the potential for observer bias.ConclusionsThe use of EVR is a simple, cheap, and practical tool that facilitates giant polyp assessment and removal. This technique may greatly benefit endoscopists in the management of giant colon polyps. A prospective controlled trial of EVR should be undertaken to further define the optimal methods and benefits for the removal of giant colon polyps.