Rate of adverse events of gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

Table 1 Characteristics of patients n (%)

Characteristics	Value
Age (yr), mean ± SD (range)	69.1 ± 11.8 (22-92)
Gender: M/F	111/197 (36/64)
Smoker	21 (6.8)
Alcohol	35 (11.4)
Cirrhosis	20 (6.5)
Anticoagulation	36 (11.7)
Indication
Iron-deficiency anemia	103 (33.4)
Polyp follow-up	68 (22.1)
Dyspepsia/ GERD	51 (16.6)
Upper hemorrhage	33 (10.7)
Pernicious anemia	7 (2.3)
Dysphagia	6 (1.9)
FAP	4 (1.3)
Others	36 (11.7)
ASA
I	34 (10.4)
II	202 (62)
III	88 (27)
IV	2 (0.6)

GERD: Gastroesophageal reflux disease; FAP: Familial adenomatous polyposis; ASA: American Society of Anesthesiologist.

Table 2 Characteristics of polyps (the biggest in case of multiple polyps) n (%)

Characteristics	Value
Paris classification of polyps
0- Is	152 (49.4)
0-Ip	156 (50.6)
Size (mm), mean ± SD (range)	15 ± 8.9 mm (5-60)
Size
5 mm	17 (5.5)
6-10 mm	109 (35.4)
11-20 mm	132 (42.9)
> 20 mm	47 (15.3)
Location
Fundus	50 (16.2)
Body	112 (36.4)
Incisura	5 (1.6)
Antrum	119 (38.6)
Pylorus	8 (2.6)
Duodenum	14 (4.5)
Physician expertise
Staff	268 (87)
Fellow	40 (13)
Polyp histology
Hyperplastic	224 (72.7)
Adenoma	29 (9.4)
Fundic glands hyperplasia	25 (8.1)
Adenocarcinoma	8 (2.6)
Inflammatory fibroid	7 (2.3)
Neuroendocrine tumor	5 (1.6)
Others1	7 (2.3)
No retrieved	2 (0.6)

¹3 Brunner's gland hamartoma, 1 gastric inflammatory pseudopolyp, 1 spindle cell lipoma, 1gastric heterotopia polyp, 1 cystic gastritis.

Table 3 Endoscopy and polypectomy technical details

Characteristics	n (%)
Sedation	302 (98.1)
University Hospital	251 (81.5)
Endoscopist Staff	268 (87)
Number of polyps resected
1	205 (66.6)
2	55 (17.9)
3	20 (6.5)
4	8 (2.6)
5	7 (2.3)
> 5	13 (4.2)
Cautery settings
Endocut	236 (76.6)
Hemorrhage prophylaxis	219 (71.1)
One technique	149 (68)
Two or more	70 (32)
Prophylactic technique
Injection alone	119 (54.3)
Clips	16 (7.3)
Clips + injection	60 (27.4)
Endoloop	9 (4.1)
Endoloop + injection	5 (2.3)
APC	5 (2.3)
APC + injection	2 (0.9)
APC+ clips + injection	3 (1.4)

APC: Argon plasma coagulation.

Table 4 Type and severity of adverse events according to ASGE lexicon

Unexpected events		Time of presentation	Severity (intraprocedural hemorrhage)	Admission or prolongation of hospitalization	Repeat endoscopy	AEs
						ASGE lexicon
Type	n = 45					n = 9	Severity
Hemorrhage	30	Intraprocedural, n = 26	Grade 1, n =11	Yes, n = 2	No	2	Mild
			Grade 3, n =14
			Grade 4, n =1
		3 d, n = 1		No	Yes	1	Moderate
		7 d, n = 2		Yes	Yes	2	Moderate (1)
							Severe (1)
		30 d, n = 1		Yes	Yes	1	Moderate
Abdominal pain	10	24 h		No	No
Respiratory desaturation	2	Intraprocedural		No	No
Pneumothorax	1	Intraprocedural		Yes	No	1	Moderate
SBP	1	7 d		Yes	No	1	Severe
Esophageal laceration	1	Intraprocedural		Yes	No	1	Mild

SBP: Spontaneous bacterial peritonitis.

Table 5 Univariate analysis of bleeding risk factors n (%)

	Bleeding, n = 30	No bleeding, n = 278	P value
Age (yr), mean ± SD	69.5 ± 10	69.1 ± 12	0.137
Gender			0.634
Male	12 (40)	99 (35.6)
Female	18 (60)	179 (64.4)
Anticoagulation1			0.217
Yes	14 (46.7)	98 (35.2)
No	16 (53.3)	180 (64.7)
ASA			0.515
I, II	20 (66.7)	201 (72.3)
III, IV	10 (33.3)	77 (27.7)
Paris classification of polyps1
0-Ip	17 (56.7)	135 (48.6)	0.399
0-Is	13 (43.3)	143 (51.4)
Polyp size1			< 0.036
≤ 10 mm	7 (23)	120 (43.2)
> 10 mm	23 (77)	158 (56.8)
Location			0.557
Stomach	28 (93.3)	266 (95.7)
Duodenum	2 (6.7)	12 (4.3)
Polyp histology1			0.092
Hyperplastic	18 (60)	206 (74.4)
Others	12 (40)	72 (25.6)
Polyp with dysplasia			0.053
Yes	8 (26.7)	36 (13.4)
No	22 (73.3)	232 (86.6)
Physician expertise1			< 0.026
Staff	30 (100)	238 (85.6)
Fellow	0 (0)	40 (14.4)
University hospital			0.207
Yes	27 (90)	224 (80.6)
No	3 (10)	54 (19.4)
Number of polyps resected			0.989
One	20 (66.7)	185 (66.5)
More than one	10 (33.3)	93 (33.4)
Use of endocut1			0.068
Yes	27 (90)	209 (75.2)
No	3 (10)	69 (24.8)
Hemorrhage prophylaxis1			0.479
Yes	23 (76.7)	196 (70.5)
No	7 (23.3)	82 (29.5)

¹Clinically relevant variables that have been included in the multivariate analysis.