Patel Akash, Treves Guy, Samreen Isha, Vaghani Utsav P
Internal Medicine, Eisenhower Health, Rancho Mirage, USA.
Medicine and Surgery, St. George's University School of Medicine, Irvine, USA.
Cureus. 2024 Mar 23;16(3):e56778. doi: 10.7759/cureus.56778. eCollection 2024 Mar.
Colorectal cancer prevention has seen significant advancements with colonoscopic polypectomy, a critical technique in clinical practice. However, postpolypectomy bleeding (PPB), particularly in the resection of large pedunculated polyps, remains a major complication. This systematic review and meta-analysis investigates the efficacy of prophylactic epinephrine injections in preventing PPB, addressing inconsistencies in the literature regarding its effectiveness. Employing a comprehensive search strategy, we rigorously selected studies for inclusion, focusing on those comparing prophylactic epinephrine with no intervention. The risk of bias was assessed using the Cochrane Risk of Bias assessment tool, ensuring a robust and reliable analysis. Our findings, based on an analysis of four studies involving 1,062 patients, indicate a significant reduction in early PPB with epinephrine use, with a marked decrease in bleeding incidence compared to the no-prophylaxis group. However, the impact on delayed bleeding was less conclusive, suggesting the need for further research in this area. Our study thus highlights the effectiveness of epinephrine as a preventive tool in colonoscopic polypectomy while underscoring the complexity of bleeding risks and the necessity for ongoing investigation in optimizing patient outcomes.
结肠镜息肉切除术是临床实践中的一项关键技术，在结直肠癌预防方面取得了重大进展。然而，息肉切除术后出血（PPB），尤其是在切除带蒂大息肉时，仍然是一种主要并发症。本系统评价和荟萃分析研究了预防性注射肾上腺素在预防PPB方面的疗效，解决了文献中关于其有效性的不一致问题。我们采用全面的检索策略，严格筛选纳入研究，重点关注那些将预防性肾上腺素与无干预措施进行比较的研究。使用Cochrane偏倚风险评估工具评估偏倚风险，以确保进行稳健可靠的分析。我们对四项涉及1062例患者的研究进行分析，结果表明，使用肾上腺素可显著降低早期PPB，与未进行预防的组相比，出血发生率显著降低。然而，对延迟出血的影响尚无定论，这表明该领域需要进一步研究。因此，我们的研究突出了肾上腺素作为结肠镜息肉切除术中预防工具的有效性，同时强调了出血风险的复杂性以及持续研究以优化患者预后的必要性。
