Z Gastroenterol 2014; 52 - A29
DOI: 10.1055/s-0034-1376089

The role of gastrointestinal endoscopy nurses in high risk colorectal polypectomy. Prevention of complications in one or two steps

M Kokas 1, G Pécsi 1
  • 1Karolina Hospital, Department of Medicine and Gastroenterology, Mosonmagyaróvár

Introduction: The endoscopic polypectomy of large pedunculated or sessile polyps involves many kinds of high risk complications, such as the haemorrhage: the occurrence of which, according to published reports varies between 0.3% and 6.1%. The most severe complication is perforation.

From the point of view of complication, polyps bigger than 1.5 cm are high-risk.

Aims and methods: The authors during 2 years conducted 179 high-risk colorectal (CR) polypectomies retrospectively. In the survey the results of the haemostatic easement methods in one or two steps used for prevention are analysed. The aim of the study was to evaluate the project data and analyse the role of endoscopy nurses.

The 4 elements:

  • In the case of CR polyps larger than 1.5 cm, 10 – 12 ml 1:10000 submucosal epinephrine-saline solution injection is given

  • standard or piece-meal polypectomy

  • search of visible vessel

  • use of haemoclip/endoloop in case of visible vessel.

Results: During the study 538 colorectal polypectomy were performed. 179 high-risk polypectomies were done in 146 patients (78 male and 68 female; mean age 61, 1 ys). The histology scope of removed polyps is the following: 125 adenoma tubulare, 25 adenoma tubulovillosum, 15 adenoma with mild dysplasia, 6 adenoma with severe dysplasia, and 11 carcinoma cases.

Prophylactic haemoclip in 84 cases, endoloop in 16 cases, clip and loop together in 2 cases were used. In 6 cases after clip using the early minor bleeding was stopped.

In 1 case due to perforation 6 hours after polypectomy an operation had to be done.

Conclusion:

  • In case of high risk polypectomy several methods of haemostatic easement are necessary

  • Haemostatic easement used according to protocol in one or two steps is efficient in the prevention of early and delayed post-polypectomy severe bleedings.

  • Prevention in complications of high-risk colorectal polypectomy needs coordinated team-work. The endoscopy nurse must be well trained in all haemostatic methods.