Endoscopic clip reduces delayed bleeding events after polyp resection
WASHINGTON — Closing mucosal defects following the removal of large colorectal polyps using an endoscopic clip was effective in reducing the incidence of delayed bleeding events and other complications, according to research presented at Digestive Disease Week.
Heiko Pohl, MD, of the VA Medical Center in White River Junction, Vt., said it was previously unknown if this kind of closure helped reduce delayed bleeding after the removal of non-pedunculated polyps at least 20 mm in size.
“The major problem with large polyp resection is really bleeding,” Pohl said in a presentation. “It occurs in 5% to 10% of resections, and it’s been a major challenge.”
Pohl and colleagues conducted a multicenter, randomized trial of 925 patients. They randomly assigned patients to an endoscopic clipping group (n = 455) or a control group (n = 470). The primary outcome was the incidence of severe delayed bleeding, defined as requiring hospitalization, transfusion or intervention to control the bleeding after the patient leaves the endoscopy unit and within 30 days of the procedure.
Pohl and colleagues found that delayed bleeding rates were lower in the endoscopic clipping group compared with the control group (3.7% vs. 7.2%; P = .02). Additionally, the rate of overall serious adverse events was lower in the clip group compared with the control group (5.3% vs. 9.8%; P = .009).
Pohl said the benefit of clipping appears to be limited to the proximal colon, where the incidence of delayed bleeding was lower in the clip group compared with the control group (3.3% vs. 9.8%; P = .001). In cases of distal polyp resection, researchers observed no protective effect of clip closure when comparing the clip and control groups. – by Alex Young
Pohl H, et al. Abstract 886. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosures: Pohl reports financial ties to Boston Scientific. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.