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Mechanical, injection therapy reduces early postpolypectomy bleeding risk
Mechanical therapy and epinephrine-saline injection therapy both reduced the risk for early bleeding after colorectal polypectomy, but no prophylactic therapies appeared to reduce the risk for delayed postpolypectomy bleeding, according to the results of a systematic review and network meta-analysis.
To compare the efficacy of prophylactic therapies for early (within 24 hours) and delayed postpolypectomy bleeding, researchers from Korea reviewed randomized controlled trial data published up to January 2016, and ultimately included 15 in their Bayesian network meta-analysis combining direct and indirect comparisons (n = 3,462).
The types of prophylactic therapies evaluated included mechanical therapy (endoclips, detachable snare or endoloops), epinephrine-saline injection therapy, coagulation therapy, combination therapy (two or more) or no prophylactic therapy.
Based on moderate quality evidence, injection therapy (RR = 0.32; 95% CI, 0.11-0.67) and mechanical therapy (RR = 0.13; 95% CI, 0.03-0.37) were superior for preventing early postpolypectomy bleeding compared with no prophylactic therapy.
Mechanical therapy and combination therapy appeared to reduce the risk for early bleeding compared with injection therapy, but this did not reach statistical significance. Rank probability analysis showed combination therapy had the highest probability of being ranked best (58.1%) followed by mechanical and injection therapy.
Finally, none of the prophylactic therapies reduced the risk for delayed bleeding compared with no prophylactic therapy.
“Both injection and mechanical therapies offer a significant advantage for reducing early postpolypectomy bleeding,” the researchers concluded, adding that “combined therapy had the highest probability of being the most effective method in the prevention of early postpolypectomy bleeding.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.