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Clip it: Closures prevent bleeding after polyp resection in proximal colon
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Clip closure helped prevent bleeding after resection of large polyps in the proximal colon, according to results of a randomized, controlled trial.
In Gastroenterology, Heiko Pohl, MD, of Dartmouth, Geisel School of Medicine, and colleagues wrote that even though endoscopic resection has become the primary strategy for removal of large polyps, incidence of serious adverse events, including post-procedure bleeding, remains a major concern.
“A few prior studies have suggested a benefit of closing the mucosal defect following the polyp resection, while others have not,” they wrote. “However, these studies were limited by retrospective design, lack of a control group, potential bias for patient selection, inclusion of smaller polyps, use of variable resection techniques, and unclear definition of outcomes.”
Researchers performed a trial comprising 919 patients with large, non-pedunculated colon polyps (20 mm) at 18 medical centers in North America and Spain between 2013 and 2017 to explore whether closing the mucosal defect with hemoclips reduced the risk for bleeding. They randomly assigned patients to undergo endoscopic closure with a clip or no closure.
The primary outcome of the study was post-procedure bleeding defined as a severe bleeding event that required hospitalization, a blood transfusion, colonoscopy, surgery or another invasive intervention within 30 days after completion of the colonoscopy.
Overall, 3.5% of patients in the clip group experienced post-procedure bleeding compared with 7.1% in the control group (absolute risk difference [ARD] = 3.6%; 95% CI, 0.7%–6.5%). Among 615 patients who had a polyp located in the proximal colon, the risk of bleeding was 3.3% in the clip group compared with 9.6% in the control group (ARD = 6.3%; 95% CI, 2.5%–10.1%).
For polyps resected from the distal colon, the risk for bleeding was 4% in the clip group compared with 1.4% in the control group (ARD = –2.6%; 95% CI, –6.3% to –1.1%). The researchers wrote that the difference could be explained by several factors, including poorer quality of clipping and shorter clip retention time possibly related to a thicker colon wall in the distal colon.
Pohl and colleagues wrote that the design of their study should help translate their findings to clinical practice.
“Our trial was methodologically rigorous, adequately powered, and all polyps were removed by endoscopic mucosal resection, which is considered the standard technique for large colon polyps in Western countries,” they wrote. “The results of the study are therefore broadly applicable to current practice. Furthermore, conduct of the study at different centers with multiple endoscopists strengthens generalizability of the findings.” – by Alex Young
Disclosures: Pohl reports receiving research funding from Boston Scientific and US Endoscopy. Please see the full study for all other authors’ relevant financial disclosures.
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