Removal of GI polyps using high-frequency electricity has become a treatment method that can replace surgery with the continuous promotion of clinical application and improvement of surgical instruments and operation methods. However, postoperative bleeding complications affect the therapeutic effect, especially delayed bleeding which is easily misdiagnosed and should be paid great attention by doctors and patients. In May 1995, the Department of Gastroenterology of our hospital successfully carried out transendoscopic high-frequency electrocoagulation removal of colonic polyps, and has treated 756 patients so far. The following is a summary report. 1, data and methods 1.1, clinical cases 756 patients with colonic polyps (500 men, 256 women), average age 38.22±15.45 years, with a history of six months to five years. There were 30 cases of recurrent fresh blood stools, abdominal pain, mucus and blood stools, abdominal distension, abdominal pain and occasional blood stools. 1.2, treatment method According to the routine preoperative preparation for colonoscopy (mannitol catheterization is contraindicated), 15min preoperative intramuscular injection of atropine 1mg or 654-210mg, all cases were biopsied at the polyps, after the pathology was reported as non-malignant, using the equipment of Olymˉpus CF-40I colonoscope, FF-99 endoscopic display system, Olympus PSD-20 high frequency electrocautery , a trap, and a polyp retriever. Routinely enter the scope to the distal polyp site, multiple polyps are excised in stages from high to low, and different treatment methods are selected according to the site, size, and morphology of the polyps, with or without a tip. Larger tipped and subtipated polyps with a diameter of 2 cm can be removed directly with a captive device into the root of the polyp, about 0.3 to 0.5 cm from the base, in one go. Wide basal polyps larger than 2 cm can be removed in stages or ligated with nylon rings; flat polyps without a tip are injected in submucosal layer at the base in 10,000:1 epinephrine saline in points, 0.5 to 1 ml per point, resulting in lesion augmentation, that is, lap sleeve removal, which can prevent bleeding and perforation, but also achieve the purpose of treatment; polyps smaller than 0.5 cm, directly removed with biopsy forceps. Electrocoagulation index 30-40 range, each time lasted about 3s, white smoke or mucous membrane at the lasso prevailed, repeated coagulation cut and gradually tighten the collar, the polyp will be cut off; polyp break off, review the residual base whitening, observe 10min no activity bleeding retreat mirror. All the cut polyps were retrieved and sent for pathological examination. 1.2. Judgment of delayed bleeding According to different lesion sites and the size of bleeding can be shown as black stool or dark red blood stool. Small amount of bleeding: black stool or dark red blood stool (distal colon lesion), 1-2 times a day, small amount each time, no dizziness, panic, normal heart rate and blood pressure, normal erythrocyte pressure product; large amount of bleeding: large amount of dark red or bright red blood stool, blood pressure ≤ 90/60 mmHg, heart rate ≥ 110/min, erythrocyte pressure product 0.3; medium amount of bleeding is between the above two. Treatment:Different hemostatic methods were selected according to the bleeding volume and bleeding site. Generally, high-frequency electrocoagulation was used to stop the bleeding, re-electrolysis of the overlong residual tip, local spraying of hemostatic agents or injection of norepinephrine saline, electrocoagulation surface coated with protective latex; anti-inflammatory and hemostatic drugs were given; blood circulation disorders were given comprehensive treatment such as blood transfusion and rehydration. 2, results 2.1, colonoscopy and pathology A total of 756 patients with polyps were detected, 514 cases of single polyps (68.0%) and 242 cases of multiple polyps (32.0%). The diameter of polyps was <0.5 cm in 469 cases (62.0%), 0.6-1.9 cm in 187 cases (24.7%) and >2.0 cm in 100 cases (13.2%); they were distributed in 241 cases (32.0%) in the rectum, 218 cases (28.8%) in the sigmoid colon, 96 cases (12.7%) in the descending colon, 76 cases (10.4%) in the transverse colon, 95 cases (12.6%) in the ascending colon and 12.6% in the ileocecal colon. 12.6%), ileocecal 30 cases (3.9%); polyps were mostly round or semicircular, with or without a tip, smooth mucosal surface or erosion and bleeding, some polyps were lobulated or irregular in shape. The pathological manifestations were adenomatous in 430 cases (56.8%), inflammatory in 160 cases (21.1%), proliferative in 68 cases (9.0%), juvenile in 72 cases (9.5%), and carcinoma in 26 cases (3.4%). 2.2, bleeding complications After high-frequency electrocoagulation resection of colonic polyp-like lesions in 756 cases in this group, there were 15 cases of delayed bleeding (11 men and 4 women) with an average age of 40.44±11.78 years and 4 cases of combined hypertensive disease. The bleeding occurred within 48 h to 5 d after high-frequency resection. Bleeding: 8 cases of small bleeding, 4 cases of medium bleeding, and 3 cases of large bleeding. 14 cases were stopped by endoscopic hemostasis or given anti-inflammatory and hemostatic drugs, and 1 case was transferred to surgery, and intraoperative hemostasis was successful under endoscopic guidance. There was no 1 case of death. 3, Discussion Endoscopic gastrointestinal polyp removal treatment, currently commonly used methods are drug injection method, high-frequency electric trap removal, thermal biopsy clamp cautery, microwave therapy, gastric freezing technology, laser therapy, radiofrequency, etc. . Various methods have their own advantages and disadvantages, the scope of application is not the same. However, the most widely used and mature technique with few complications is high-frequency electrocoagulation removal of GI polyps. We treated 756 cases of colonic polyps with high frequency electrocoagulation, and all of them were successful. The minimum age was 12 years old and the maximum age was 65 years old. The pathological results of this group: inflammatory polyps were the most frequent (18/30), followed by adenomas (8/30), which is basically consistent with the literature. Domestic scholars believe that the indications for high-frequency electrocoagulation colonic polyp removal are: 1) polyps and adenomas with various sizes; 2) non-tipped polyps and adenomas <2 cm; 3) scattered and multiple polyps in the colon. Contraindications are: 1, those who have contraindications to gastrointestinal endoscopy; 2, those with >2cm untied polyps and adenomas; 3, those with cancerous polyp form or confirmed by pathological examination; 4, those with multiple polyp lesions densely distributed in a certain area. The incidence of delayed bleeding in high-frequency electrocoagulation resection is low, generally 0.4%-2%, especially in lesions larger than 2.0 cm. The incidence of delayed hemorrhage in our group was 2%, which was generally consistent with the literature. The causes of delayed bleeding may be related to the following factors: 1, inadequate electrocoagulation; 2, the diameter of the tip of colon polyps and polyp-like lesions >2 cm, incomplete sleeve cutting, and too long residual tip; 3, the electrocoagulation surface is located at the larger vessels, secondary infection due to the electrocoagulation surface; 4, poor vascular elasticity; 5, poor control of diet and activity of patients after resection, etc. In order to avoid the occurrence of delayed bleeding, we should pay attention to the detailed understanding of the patient’s general condition, polyp size, coagulation function, and whether to take anticoagulants before high-frequency electrocoagulation resection; select a good electrocoagulation index according to the size of the lesion during surgery, and fully electrocoagulate; use latex to protect the electrocoagulation surface after surgery, and strictly control the diet and exercise. In summary:High-frequency electrocoagulation removal of colon polyps is a simple method with no significant patient pain and low cost, and will be the most mature endoscopic interventional treatment technique after strict control of bleeding complications.