Background and Aims
Prophylactic application of a hemoclip has been suggested as an alternative to the
use of an endoloop for the prevention of postpolypectomy bleeding (PPB) when resecting
large, pedunculated colorectal polyps. Therefore, this multicenter, randomized controlled
trial investigated the efficacy of prophylactic hemoclip application to reduce PPB
during the resection of large pedunculated polyps.
Methods
Large pedunculated polyps (≥10 mm in head diameter) were eligible for inclusion. Polyps
were randomized into a study arm (where clips were applied before resection) and a
control arm (without pretreatment). The primary outcome was the rate of PPB in each
group. PPB included immediate PPB (IPPB) and delayed PPB (DPPB). IPPB was defined
as blood oozing (≥1 minute) or active spurting occurring immediately after polyp resection.
DPPB was defined as rectal bleeding, occurring after completion of the colonoscopy.
Results
In total, 238 polyps from 204 patients were randomized into the clip arm (119 polyps)
or the control arm (119 polyps). Overall bleeding adverse events were observed in
20 cases (IPPB, 16; DPPB, 4). The rate of overall PPB, IPPB, and DPPB was 8.4%, 6.7%,
and 1.7%, respectively, for all polyps. The rate of overall PPB (clip 4.2% vs control
12.6%, P = .033) and IPPB (clip 2.5% vs control 10.9%, P = .017) was significantly lower in the clip arm than the control arm.
Conclusions
Prophylactic clipping before resecting large pedunculated polyps can reduce overall
PPB and IPPB compared with no prior treatment. Therefore, prophylactic clipping may
be considered before resection of large pedunculated polyps. (Clinical trial registration
number: NCT02156193.)
Graphical abstract
Graphical Abstract
Abbreviations:
DPPB (delayed postpolypectomy bleeding), IPPB (immediate postpolypectomy bleeding), PPB (postpolypectomy bleeding)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complications of colonoscopy.Gastrointest Endosc. 2011; 74: 745-752
- Quality is the key for emerging issues of population-based colonoscopy screening.Intest Res. 2018; 16: 48-54
- Histological comparison of cold versus hot snare resections of the colorectal mucosa.Dis Colon Rectum. 2018; 61: 964-970
- Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors.Gut. 2017; 66: 1779-1789
- Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study.Endoscopy. 2004; 36: 860-863
- Morphometric study of the blood supply of pedunculated colon polyps: What is the optimal position on the stalk for snare resection?.Endosc Int Open. 2015; 3: E655-E658
- Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study.Surg Endosc. 2009; 23: 2732-2737
- A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps.Am J Gastroenterol. 2006; 101 (quiz 2913): 2805
- Endoclip-assisted resection of large pedunculated colorectal polyps: technical aspects and outcome.Dig Dis Sci. 2010; 55: 1726-1731
- Comparison of prophylactic clip and endoloop application for the prevention of postpolypectomy bleeding in pedunculated colonic polyps: a prospective, randomized, multicenter study.Endoscopy. 2014; 46: 598-604
- Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.Endoscopy. 2017; 49: 270-297
- Endoscopic snare excision of large pedunculated colorectal polyps: a new, safe, and effective technique.Endoscopy. 2001; 33: 854-857
- Comparison of clipping with and without epinephrine injection for the prevention of post-polypectomy bleeding in pedunculated colon polyps.J Gastroenterol Hepatol. 2015; 30: 1499-1506
- The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.Gastrointest Endosc. 2009; 69: 620-625
- Comparison of bowel-cleansing efficacy of split-dose and same-day dose bowel preparation for afternoon colonoscopy in patients with gastrectomy: a prospective randomized study.Surg Endosc. 2020; 34: 4413-4421
- Validation of same-day bowel preparation regimen using 4L polyethylene glycol: comparison of morning and afternoon colonoscopy.Medicine (Baltimore). 2018; 97: e12431
- Comparison of bowel cleansing efficacy, safety, bowel movement kinetics, and patient tolerability of same-day and split-dose bowel preparation using 4 l of polyethylene glycol: a prospective randomized study.Dis Colon Rectum. 2019; 62: 1518-1527
- Effect of dynamic position changes on adenoma detection during colonoscope withdrawal: a randomized controlled multicenter trial.Am J Gastroenterol. 2016; 111: 63-69
- Comparison of adenoma detection by colonoscopy between polypectomy performed during both insertion and withdrawal versus during withdrawal only: a multicenter, randomized, controlled trial.Surg Endosc. 2020; 34: 5461-5468
- Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate postpolypectomy bleeding.BMC Gastroenterol. 2020; 20: 68
- Efficacy of prophylactic hemoclips in prevention of delayed post-polypectomy bleeding in patients with large colonic polyps.Gastroenterology. 2019; 157: 967-976
- A multicenter, single-blind randomized controlled trial of endoscopic clipping closure for preventing coagulation syndrome after colorectal endoscopic submucosal dissection.Gastrointest Endosc. 2020; 91: 859-867
Article info
Publication history
Published online: January 05, 2021
Accepted:
December 20,
2020
Received:
October 12,
2020
Footnotes
DISCLOSURE: All authors disclosed no financial relationships. Research support for this study was provided by the Catholic Medical Center Research Foundation made in the program year 2015 (XC14EIME0028O, JSJ).
See CME section, p. 178.
If you would like to chat with an author of this article, you may contact Dr Ji at [email protected]
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
ScienceDirect
Access this article on ScienceDirectLinked Article
- Prioritizing an oncologic approach to endoscopic resection of pedunculated colorectal polypsGastrointestinal EndoscopyVol. 94Issue 1
- PreviewIn this issue of Gastrointestinal Endoscopy, Gweon et al1 report a randomized controlled trial (RCT) of the effect of prophylactic clipping of the stalks of pedunculated polyps on hemorrhage risk. Placement of a median of 1.7 clips (placed before transection with snare cautery) on the stalk was effective in preventing overall hemorrhage risk, although this resulted entirely from preventing immediate arterial hemorrhage. There were 2 delayed hemorrhages in the clip and untreated arms each. Thus, placement of hemostatic clips on the stalks of pedunculated polyps was effective in preventing immediate hemorrhage at the time of transection.
- Full-Text
- Preview
