MEASURES TO REDUCE POST-POLYPECTOMY BLEEDING IN PEDUNCULATED POLYPS - DOES A CLIP HELP?

Aims Immediate and delayed post-polypectomy bleeding (PPB) is a serious complication after endoscopic removal of large pedunculated polyps. Options to decrease risk of bleeding include injecting the stalk with adrenaline, placing clips across the stalk (before or after the polypectomy) and placement of a nylon loop around the stalk. The principle of closing a defect to reduce complications is well established but the cost effectiveness of prophylactic clipping remains controversial. There are currently no consensus guidelines. We aimed to investigate the use of endoscopic clips during polypectomy of pedunculated polyps >10mm and assess its association with PPB.

Methods Large retrospective study across two sites at a tertiary London-based hospital Trust. Endoscopy software (Unisoft GI reporting tool) was used to identify pedunculated polyps >10mm in size during a 5 year period (January 2014 to March 2019). Patients that did not undergo polypectomy were excluded.

Results 657 polypectomies performed for pedunculated polyps (mean age 65.2 (range 22 - 94), Female 240 (36.5%)). Mean pedunculated polyp size 16.4mm (10 - 60mm). 636 (96.8%) hot snare polypectomy; 264 (40.2%) injected with adrenaline. Endoscopic clip used in 191 (29%). Total immediate (< 6hrs) and delayed bleeding (6hrs to 2 weeks) events were 11 (1.7%) and 14 (2.1%), respectively. Endoscopic clip use was associated with adrenaline injection (60.2% vs. 32%, p< 0.0001) and immediate bleeding (4.7% vs. 0.4%, p = 0.0001).

Conclusions Endoscopic clip use was associated with more immediate bleeding events suggesting that it is being used as a treatment strategy (not prophylactically) to achieve haemostasis. Endoscopic clips are being deployed more often with larger polyps and in combination with adrenaline injection. Whilst there is clear guidance from national and international bodies on how to remove sessile polyps, the optimal technique for resection of pedunculated polyp is less clear and this may account for the variability in clinical practice.