Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage

Experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions

Hammad Liaquat, Elizabeth Rohn, Douglas Rex

Research output: Contribution to journalArticle

122 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)401-407
Number of pages7
JournalGastrointestinal Endoscopy
Volume77
Issue number3
DOIs
StatePublished - Mar 2013

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Surgical Instruments
Hemorrhage
Odds Ratio
Transverse Colon
Polyps
Telephone
Tertiary Care Centers
Multivariate Analysis
Retrospective Studies

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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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. / Liaquat, Hammad; Rohn, Elizabeth; Rex, Douglas.

In: Gastrointestinal Endoscopy, Vol. 77, No. 3, 03.2013, p. 401-407.

Research output: Contribution to journalArticle

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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.",
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N2 - 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.

AB - 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.

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