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

Thawatchai Tullavardhana, Prinya Akranurakkul, Withoon Ungkitphaiboon, Dolrudee Songtish, Thawatchai Tullavardhana, Prinya Akranurakkul, Withoon Ungkitphaiboon, Dolrudee Songtish

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.

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.

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