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.
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.
Authors: R Manta; F Tremolaterra; A Arezzo; M Verra; G Galloro; L Dioscoridi; F Pugliese; A Zullo; M Mutignani; G Bassotti Journal: Tech Coloproctol Date: 2015-07-11 Impact factor: 3.781
Authors: Yunho Jung; Il Kwun Chung; Young Sin Cho; Tae Hoon Lee; Sang-Heum Park; Ji Sung Lee; Sun Joo Kim Journal: Dig Dis Sci Date: 2015-06-12 Impact factor: 3.199
Authors: Heiko Pohl; Ian S Grimm; Matthew T Moyer; Muhammad K Hasan; Douglas Pleskow; B Joseph Elmunzer; Mouen A Khashab; Omid Sanaei; Firas H Al-Kawas; Stuart R Gordon; Abraham Mathew; John M Levenick; Harry R Aslanian; Fadi Antaki; Daniel von Renteln; Seth D Crockett; Amit Rastogi; Jeffrey A Gill; Ryan J Law; Pooja A Elias; Maria Pellise; Michael B Wallace; Todd A Mackenzie; Douglas K Rex Journal: Gastroenterology Date: 2019-03-15 Impact factor: 22.682