Boujaoudé Joseph, Honein Khalil, Hobeika Elham, Yaghi César, Slim Rita, Sayegh Raymond
Service d'Hépato-Gastro-Entérologie, Hôpital Hôtel-Dieu de France, Faculté de Médecine, Université Saint-Joseph, Beyrouth, Liban.
J Med Liban. 2006 Oct-Dec;54(4):221-4.
Endoscopic polypectomy is now an established procedure for the resection of colorectal polyps. One of the serious complications associated with colonoscopic polypectomy is hemorrhage. Several factors appear to be associated with increased risk of hemorrhage including patient age and colorectal polyp size, location, and morphology (thick stalk or sessile). In particular, resection of large polyps is associated with a higher risk of serious complications. Bleeding most often occurs within the first 24 hours. More than 95% of cases of bleeding can be treated endoscopically by epinephrine injection, heater probe, or band ligation, alone or in combination. Several methods have been proposed for the prevention of hemorrhage after polypectomy. The most interesting approach is the use of a detachable snare (Endoloop) which allows endoscopic ligation of the stalk of a large, pedunculated polyp. In order to avoid the more severe consequences of bleeding, we use a detachable snare in two patients with a pedunculated polyp with a large head and stalk (> 2 cm). In a third patient receiving anticoagulant, a detachable snare was chosen to safely and completely remove a large pedunculated polyp > 1.5 cm. In conclusion, colonoscopic polypectomy with Endoloop is safer than conventional polypectomy alone for resection of large, pedunculated polyps, especially in patients with liver disease, coagulopathy and receiving anticoagulant.
内镜下息肉切除术现已成为切除大肠息肉的既定手术方法。与结肠镜息肉切除术相关的严重并发症之一是出血。有几个因素似乎与出血风险增加有关，包括患者年龄、大肠息肉的大小、位置和形态（粗蒂或无蒂）。特别是，切除大息肉与严重并发症的风险较高有关。出血最常发生在最初24小时内。超过95%的出血病例可通过单独或联合使用肾上腺素注射、热探头或套扎术进行内镜治疗。已经提出了几种预防息肉切除术后出血的方法。最有趣的方法是使用可拆卸圈套器（Endoloop），它可以在内镜下结扎大的有蒂息肉的蒂。为了避免出血的更严重后果，我们对两名患有大头和粗蒂（>2 cm）有蒂息肉的患者使用了可拆卸圈套器。在第三名接受抗凝治疗的患者中，选择了可拆卸圈套器以安全、完全地切除一个>1.5 cm的大的有蒂息肉。总之，对于切除大的有蒂息肉，尤其是患有肝病、凝血功能障碍和接受抗凝治疗的患者，使用Endoloop进行结肠镜息肉切除术比单纯传统息肉切除术更安全。
