Original articleClinical endoscopyPolidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis

BackgroundEMR is the standard of care for the resection of large polyps.ObjectiveTo compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare.DesignAfter 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection.SettingEndoscopic suite at the University of Foggia between 2005 and 2014.PatientsOf 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching.InterventionsSubmucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients.Main Outcome MeasurementsUnivariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB).ResultsThe 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).LimitationsAbsence of randomization.ConclusionThe submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate.