Efficacy of cyanoacrylate in the prevention of delayed bleeding after endoscopic mucosal resection of large colorectal p
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Efficacy of cyanoacrylate in the prevention of delayed bleeding after endoscopic mucosal resection of large colorectal polyps: a pilot study Gennaro Martines 1 & Arcangelo Picciariello 1 & Rigers Dibra 1 & Giuseppe Trigiante 1 & O. Caputi Jambrenghi 1 & Nicola Chetta 1 & Donato Francesco Altomare 1,2,3 Accepted: 17 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Postoperative bleeding is a common complication after endoscopic polypectomy, particularly after endoscopic mucosal resection (EMR) of large non-pedunculated polyps, despite prophylactic clipping can reduce its occurrence. Cyanoacrylate glue has recently been proposed as a useful tool in reducing bleeding in surgery because of its adhesive and haemostatic properties. The aim of this study is to evaluate the usefulness of endoscopic application of a modified cyanoacrylate glue in the prevention of early or delayed post EMR bleeding. Methods This is a pilot study. Inclusion criteria were patients between 18 and 75 years old affected by sessile or flat colonic polyps larger than 2 cm. Patients enrolled in the study were randomized in two groups: group A (EMR) and group B (EMR with the application of 0.3 ml of N-butyl-2-cyanoacrylate + methacryloxysulfolane—Glubran 2®). Results Fifteen patients in both group A and B were enrolled. There were no intraoperative complications but haemostatic clipping was necessary in 3 patients in each group because of active bleeding. Delayed (after 24 h) bleeding occurred in two patients (13.3%) in group A requiring hospital readmission and re-do endoscopy with apposition of haemostatic clips. No case of bleeding was recorded in group B (p = 0.48). Conclusion The results of this pilot study suggest a potential role of local spray application of Glubran®2 in reducing postprocedural bleeding. Keywords Colorectal polyps . EMR . Bleeding . Cyanoacrylate glue
Introduction Endoscopic screening with detection of early stage cancer or adenomatous polyps has widely contributed to reduce both mortality and incidence of colorectal cancer [1]. In fact, the identification of colonic precancerous lesions such as large non-pedunculated adenomas allows a safe * Donato Francesco Altomare [email protected] 1
Department of Emergency and Organ transplantation, Surgical Unit “M.Rubino”, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
2
IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
3
Department of Emergency and Organ Transplantation, University “Aldo Moro” of Bari, Piazza G Cesare, 11, 70124 Bari, Italy
endoscopic management, potentially preserving patients from the morbidity of colon and/or rectal surgical resection and cancer progression [2]. Endoscopic mucosal resection (EMR) has been reported to be a safe and effective technique for removal of large nonpedunculated polyps, even if, in case of polyps larger than 3 cm, the risk of complication and recurrence is higher [3]. Their resection can be performed en bloc or piecemeal according to the s
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