Morphometric study of the blood supply of pedunculated colon polyps: What is the optimal position on the stalk for snare resection?

Background and study aims: Bleeding after colonoscopic resection of pedunculated polyps cannot be easily predicted. The aims of this study were to evaluate the blood supply in pedunculated polyps and to clarify the optimal position on the polyp stalk for snare placement to prevent post-polypectomy hemorrhage.
]Patients and methods: In one institution, 11 pedunculated polyps from 11 patients were studied prospectively. All polyps were resected at the base of the stalk using a snare wire with electrocautery. Histologic axial sections from the apex and base of the stalk were examined with hematoxylin eosin and elastica stains. Elastica stains were used to identify blood vessels. The cross-sectional area of the stalk, total vessel area, maximum diameter of artery/arteriole lumen, number of thick (≥ 0.1 mm) vessels, and number of arteries/arterioles were measured in each section with image processing software. Wilcoxon signed-ranks test was used for comparison.

Results: The median polyp diameter was 16 mm (range 7 to 24 mm) and median length of the stalk was 11 mm (range 7 to 23 mm). Two invasive cancers (T1) were included. The maximum diameter of the arterial/arteriolar lumen was greater at the base (P = 0.0044), whereas the ratio of the vessel area to the cross-section area was greater at the apex (P = 0.016). The number of thick vessels and arteries/arterioles were equivalent between apex and base.

Conclusions: Morphometric study of the blood supply of pedunculated polyps confirmed that the optimal site for the excision of pedunculated polyps is in the middle of the stalk.

• References

• 1 Dominitz JA, Eisen GM, Baron TH et al. Complications of colonoscopy. Gastrointest Endosc 2003; 57: 441-445
• 2 Rosen L, Bub DS, Reed JF 3rd et al. Hemorrhage following colonoscopy polypectomy. Dis Colon Rectum 1993; 36: 1126-1131
• 3 Macrae FA, Tan GK, Williams CB. Towards safer colonoscopy: a report on the complication of 5000 diagnostic or therapeutic colonoscopies. Gut 1983; 24: 376-381
• 4 Rex DK, Lewis BS, Waye JD. Colonoscopy and endoscopic therapy for delayed post-polypectomy hemorrhage. Gastrointest Endosc 1992; 38: 127-129
• 5 Buddingh KT, Herngreen T, Haringsma J et al. Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study. Am J Gastroenterol 2011; 106: 1119-1124
• 6 Dobrowolski S, Dobosz M, Babicki A et al. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc 2006; 63: 1004-1009
• 7 Sorbi D, Norton I, Conio M et al. Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 2000; 51: 690-696
• 8 Hui AJ, Wong RM, Ching JY et al. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc 2003; 59: 44-48
• 9 Di Giorgio P, De Luca L, Calcagno G et al. Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study. Endoscopy 2004; 36: 860-863
• 10 Liaquat H, Roth E, Rex DK. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77; 401-407
• 11 Lishi H, Tatsuta M, Narahara H et al. Endoscopic resection of large pedunculated colorectal polyps using a detachable snare. Gastrointest Endosc 1996; 44: 594-597
• 12 Waye JD, Rex DK, Williams CB. Colonoscopy: Principles and Practice. Second edition Hoboken, NJ: Wiley-Blackwell; 2009: 578-579
• 13 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to Image: 25 years of image analysis. Nature Methods 2012; 9: 671-675
• 14 Feagins LA, Nguyen AD, Iqbal R et al. The prophylactic placement of hemoclips to prevent delayed post-polypectomy bleeding: an unnecessary practice? A case control study. Dig Dis Sci 2014; 59: 823-828
• 15 Shioji K, Suzuki Y, Kobayashi M et al. Prophylactic clip application dose not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 2003; 57: 691-694