Endoscopic ultrasonography for prediction of postpolypectomy bleeding in patients with large nonpedunculated rectosigmoid adenomas.

Abstract

Case reports suggest that endosonographic visualization of blood vessels in a gastric polyp may be predictive of risk of postpolypectomy bleeding; however, this issue has never been studied in patients with colorectal adenomas. Endosonography (EUS) was performed prior to endoscopic polypectomy of 42 large (>/= 20 mm) nonpedunculated adenomatous polyps. The median diameter of the polyps was 30 mm (range 20-100 mm); 35 were located in the rectum and seven in the sigmoid colon. During EUS both the polyp and the bowel wall underneath were searched for the presence of vessels, which were defined as longitudinal/tortuous or round/oval echo-free structures >/= 2 mm in diameter. The polyp was visualized adequately in 39 cases; three cases were excluded from analysis due to inadequate visualization. In eight polyps (20.5%, group 1) EUS revealed vessels measuring 2-4 mm; in 31 polyps (79.5 %, group 2) no vessels were found. The postpolypectomy bleeding incidence (per polyp treated) was 12.5% in group 1 and 12.9 % in group 2 (P>0.05). In this small series of patients with large nonpedunculated rectosigmoid adenomas, the EUS image of the polyp was not predictive of postpolypectomy bleeding. The detection of vessels on EUS did not increase the risk for bleeding; however, the sample size was to small to draw definite conclusions. The absence of vessels on EUS did not rule out the possibility of bleeding.