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Endoscopic resection of pedunculated polyps mainly focuses on how to prevent bleeding, and also needs to pay attention to the convenience of resection and the integrity of resection, which means that different endoscopic resection strategies should be adopted for pedunculated polyps with different pedicle sizes. The head larger than 20mm or pedicle larger than 5mm are defined as large pedunculated polyps, which are at greater risk of bleeding. Current guidelines recommend hot removal by snare following preoperative saline injection, ligation of the pedicle with a nylon ring or metal clip, depending on the size of the polyp head and pedicle. However, the use of snares and metal clamps does not appear to reduce delayed postoperative bleeding, and the technical requirements of nylon ligation are relatively high. Recent studies have found that Underwater endoscopic mucosal resection (UEMR) is also safe and effective for the treatment of large and medium colorectal sessile polyps. Therefore, it is still necessary to further explore new safe and effective endoscopic resection strategies and techniques.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| underwater endoscopic mucosal resection | Experimental | underwater endoscopic mucosal resection for resection of big pedunculated colorectal polyps |
|
| hot snare polypectomy | Active Comparator | hot snare polypectomy for resection of big pedunculated colorectal polyps |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| underwater endoscopic mucosal resection | Other | underwater endoscopic mucosal resection achieves similar rates of complete resection with comparable safety, with lower rates of recurrence and fewer repeat procedures. |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of immediate bleeding | Immediate bleeding was defined as an intraoperative bleeding immediately after Immediate bleeding staging: If there is no bleeding, fill in 'none'; Level 1, spontaneous hemostasis within 60 seconds; Level 2, continuous small bleeding for more than 60 seconds; Level 3, continuous bleeding for more than 60 seconds requires endoscopic treatment; Level 4, arterial spray | 1 Minutes |
| Measure | Description | Time Frame |
|---|---|---|
| delayed hemorrhage | Any symptoms of gastrointestinal bleeding (e. g. hematochezia) occurred within 30 days after polypectomy and were classified as mild or severe according on the severity of the bleeding | 2 weeks and 4 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Immediate perforation rate | perforation | 30 seconds |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Lei Xu | Contact | +8613486659126 | xulei22@163.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| the First Affiliated Hospital of Ningbo University | Recruiting | Ningbo | Zhejiang | 315000 | China |
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| hot snare polypectomy | Other | Current guidelines recommend preoperative hot snare polypectomy after preoperative saline injection, nylon ring, or metal clip ligation of the tip and pedicle of the polyps |
|
| ID | Term |
|---|---|
| D006470 | Hemorrhage |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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