Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2017; 23(47): 8405-8414
Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8405
Rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study
Henry Córdova, Lidia Argüello, Carme Loras, Antonio Naranjo Rodríguez, Faust Riu Pons, Joan B Gornals, David Nicolás-Pérez, Xavier Andújar Murcia, Luis Hernández, Santos Santolaria, Carles Leal, Carles Pons, Enrique Pérez-Cuadrado-Robles, Orlando García-Bosch, Michel Papo Berger, José Luis Ulla Rocha, Cristina Sánchez-Montes, Gloria Fernández-Esparrach
Henry Córdova, Cristina Sánchez-Montes, Gloria Fernández-Esparrach, Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona 08036, Spain
Lidia Argüello, Digestive Endoscopy Unit, Digestive Diseases Department, Gastrointestinal Endoscopy Research Group, IIS, La Fe Polytechnic University Hospital, Valencia 46026, Spain
Carme Loras, Xavier Andújar Murcia, Hospital Universitari Mútua de Terrassa, CIBERehd, Terrassa 08221, Spain
Antonio Naranjo Rodríguez, Hospital Reina Sofía, Córdoba 14004, Spain
Faust Riu Pons, Hospital Del Mar, Barcelona 08003, Spain
Joan B Gornals, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona 08907, Spain
David Nicolás-Pérez, Hospital Universitario de Canarias, Santa Cruz de Tenerife 38320, Spain
Luis Hernández, Hospital Santos Reyes, Aranda de Duero, Burgos 09400, Spain
Santos Santolaria, Hospital San Jorge, Huesca 22004, Spain
Carles Leal, Consorci Hospitalari de Vic, Universitat de Vic, Vic 08500, Spain
Carles Pons, Hospital de Viladecans, Viladecans, Barcelona 08840, Spain
Enrique Pérez-Cuadrado-Robles, Hospital Morales Meseguer, Murcia 30008, Spain.
Orlando García-Bosch, Hospital Moisès Broggi, Sant Joan Despí, Barcelona 08970, Spain
Michel Papo Berger, Hospital Joan XXIII, Tarragona 43005, Spain
José Luis Ulla Rocha, Complejo Hospitalario de Pontevedra, Pontevedra 36164, Spain
Author contributions: Córdova H and Fernández-Esparrach G designed research and wrote the paper; Córdova H, Argüello L, Loras C, Naranjo Rodríguez A, Riu Pons F, Gornals JB, Nicolás-Pérez D, Andújar Murcia X, Hernández L, Santolaria S, Leal C, Pons C, Pérez-Cuadrado-Robles E, García-Bosch O, Papo Berger M, Ulla Rocha JL and Fernández-Esparrach G performed research; Córdova H, Sánchez-Montes C and Fernández-Esparrach G contributed new reagents or analytic tools; Córdova H, Sánchez-Montes C and Fernández-Esparrach G analyzed data.
Institutional review board statement: The study was reviewed and approved by the Hospital Clinic Institutional Review Board.
Informed consent statement: All involved persons (subjects or legally authorized representative) gave their written informed consent prior to study inclusion.
Conflict-of-interest statement: None of the authors of this manuscript, Henry Córdova, Lidia Argüello, Carme Loras, Antonio Naranjo Rodríguez, Faust Riu Pons, Joan B Gornals, David Nicolás-Pérez, Xavier Andújar Murcia, Luis Hernández, Santos Santolaria, Carles Leal, Carles Pons, Enrique Pérez-Cuadrado-Robles, Orlando García-Bosch, Michel Papo Berger, José Luis Ulla Rocha, Cristina Sánchez-Montes, Gloria Fernández-Esparrach have any conflicts of interest or financial ties to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at mgfernan@clinic.ub.es.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gloria Fernández-Esparrach, MD, PhD, Endoscopy Unit. Institut de Malalties Digestives, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain. mgfernan@clinic.ub.es
Telephone: +34-93-2275400 Fax: +34-93-2279387
Received: September 1, 2017
Peer-review started: September 3, 2017
First decision: September 20, 2017
Revised: October 3, 2017
Accepted: October 26, 2017
Article in press: October 26, 2017
Published online: December 21, 2017
Processing time: 109 Days and 19.4 Hours
Abstract
AIM

To evaluate the rate of adverse events (AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers.

METHODS

Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after the procedure.

RESULTS

308 patients were included and a single polypectomy was performed in 205. Only 36 (11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm (5-60) and in 294 cases (95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219 (71.1%) patients. Nine patients presented AEs (2.9%), and 6 of them were bleeding (n = 6, 1.9%) (in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.

CONCLUSION

Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.

Keywords: Polypectomy; Bleeding; Adverse events; Protruded polyps; Gastroduodenal; Foregut

Core tip: The safety of polypectomy in the upper gastroduodenal tract is controversial because the reported rate in retrospective studies is higher than in colonic polypectomy but results come mainly from retrospective studies and they do not use the same standardized nomenclature and definitions for adverse events. To our knowledge, this is the first study using the ASGE lexicon for reporting adverse events of gastro-duodenal polypectomy and shows an acceptable low rate, confirming the safety of this procedure.