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Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.

Abstract：

BACKGROUND:Endoscopic resection of large colorectal lesions is associated with high complication rates. OBJECTIVE:To evaluate the effect of prophylactic clip closure of polypectomy sites after resection of large (≥2 cm) sessile and flat colorectal lesions. DESIGN:Retrospective study. SETTING:Tertiary referral center. PATIENTS AND INTERVENTIONS:Patients with lesions 2 cm or larger who underwent EMR performed by using low-power coagulation current between January 2000 and February 2012. Beginning in June 2006, polypectomy sites were prophylactically closed with clips when possible. Patients had telephone follow-up at 30 days or later to track complications. MAIN OUTCOME MEASUREMENTS:Delayed hemorrhage, postpolypectomy syndrome, and perforation. RESULTS:There were 524 lesions 2 cm or larger in 463 patients, of which 247 (47.1%) were not clipped, 52 (9.9%) were partially clipped, and 225 (42.9%) were fully clipped. There were 31 delayed hemorrhages, 2 perforations, and 6 cases of postpolypectomy syndrome. The delayed hemorrhage rate was 9.7% in the not clipped group versus 1.8% in the fully clipped group. Multivariate analysis showed that not clipping (odds ratio [OR] 6.0; 95% CI, 2.0-18.5), location proximal to the splenic flexure (OR 2.9; 95% CI, 1.05-8.1), and polyp size (OR 1.3; 95% CI, 1.1-1.7 for each 10-mm increase in size) were associated with delayed bleeding. LIMITATION:Retrospective design. CONCLUSIONS:Prophylactic clipping of resection sites after endoscopic removal of large (≥2 cm) colorectal lesions using low-power coagulation current reduced the risk of delayed postpolypectomy hemorrhage. A randomized, prospective trial of clipping large polypectomy sites is warranted.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Liaquat H,Rohn E,Rex DK

doi

10.1016/j.gie.2012.10.024

subject

Has Abstract

pub_date

2013-03-01 00:00:00

pages

401-7

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(12)02860-X

journal_volume

pub_type

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Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.