This article is more than 5 years old. Information may no longer be current.
Full clip closure of colorectal lesions protects against delayed bleeding
Clip closure of mucosal defects helped reduce delayed bleeding in patients who underwent endoscopic mucosal resection, according to study results.
However, to achieve this reduction in bleeding risk, the clip closures must be complete.
Eduardo Albéniz, MD, of the gastroenterology department of Complejo Hospitalario de Navarra, in Spain, and colleagues wrote in Gastroenterology that several techniques are used to prevent delayed bleeding after endoscopic mucosal resection (EMR), with clips becoming more common.
“Closure of a mucosal defect with clips after resection has long been considered to reduce the risk of bleeding,” they wrote. “Although the application of clips after EMR is increasing, there is scarce evidence to support this practice.”
Researchers performed a single-blind trial comprising 235 patients who underwent EMR for large nonpedunculated colorectal lesions (LNPCLs) with an average or high risk for delayed bleeding based on the Spanish endoscopy society endoscopic resection group score. They randomly assigned patients to groups that either received closure of the scar with 11 mm through-the-scope clips (n = 119) or no clip (n = 116).
The primary outcome of the study was the proportion of patients in each group with delayed bleeding, defined as evident hematochezia that required medical attention within 15 days of colonoscopy.
In the group that received clip closures, endoscopists achieved complete closure in 68 cases (57%), partial closure in 33 cases (28%) and failed to close in 18 cases (15%). In the control group, 14 patients experienced delayed bleeding (12.1%) compared with 6 patients (5%) in the clip group (absolute risk difference, reduction of 7% in the clip group; 95% CI, –14.7% to 0.3%)
Among patients who had completed clip closure, there was just one case of delayed bleeding (absolute risk difference, reduction of 10.6%; 95% CI, –4.3% to 17.9%). Polyps that were successfully clipped were generally smaller and had shorter and easier EMR procedure, according to investigators.
“This multicenter clinical trial shows that complete clip closure of mucosal defects after resection of large colon lesions, in selected patients with higher than average estimated delayed bleeding risk, can be a challenging technique but displays a clear trend to reduce delayed bleeding risk,” Albéniz and colleagues wrote. “The protective effect is limited to cases where complete clip closure is achieved.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.