Comparative analysis of the results of using mechanical methods of prophylactic hemostasis in endoscopic removal of large polypoid masses of colon mucosa

INTRODUCTION: Bleeding is the most common complication of endoscopic resection of mucous membrane of a hollow organ, which most often accompanies removal of large polypoid masses (PMs). However, currently endoscopic techniques have been developed that allow for effective prevention of this complication.

AIM: Comparison of the effectiveness of endoscopic methods of preventing bleeding when removing large PMs of colonic mucosa: prophylactic clipping and prophylactic ligation of polyp stalk.

MATERIALS AND METHODS: The study included patients with single pedunculated PMs with a feeding stalk of ≥ 5 mm thickness, located in different parts of the colon. Exclusion criteria were the presence of other large (≥ 10 mm) epithelial masses in the colon, as well as the use of antiplatelet agents and anticoagulants. Patients of group A (n = 32) were planned to undergo bleeding prevention by ligating the PM stalk using an original ligating device, patients of group B (n = 32) by prophylactic clipping of the stalk with a metal endoclip. The time of surgical intervention, intraoperative and immediate postoperative bleeding rate were compared, and technical difficulties in the use of prophylactic hemostasis techniques were recorded.

RESULTS: Sixty-one out of sixty-four surgical interventions were performed without technical difficulties. In two cases, prophylactic clipping of the stalk was initially planned, but during the surgical intervention ligation was used due to technical peculiarities of the operation. The average time of surgical intervention using the prophylactic ligation method was (16 ± 3) minutes, using clipping — (12 ± 2) minutes. No bleeding was recorded during surgical interventions and in the immediate postoperative period in any of study cases.

CONCLUSION: Both methods provide reliable prophylactic hemostasis, effective in almost 100% of cases. However, the prophylactic clipping method has a number of technical limitations: it should be used with caution when removing a PM with a short or a thick stalk. In these cases, the method of choice for the endoscopist may be the prophylactic ligation.