COMPARISON OF ENDOCLOT, A NOVEL POLYSACCHARIDE HAEMOSTATIC AGENT, AND ENDOSCOPIC CLIPPING IN THE PREVENTION OF POST POLYPECTOMY HAEMORRHAGE - A RETROSPECTIVE COHORT STUDY

Aims Post polypectomy haemorrhage (PPH) can occur in 6-10% of cases of colonic polyps > 20mm. Risk factors suggested include lesion size, proximal location and use of anticoagulants or antiplatelets. Topical haemostats and clips could be used for prevention. Our study compares their use for resections > 20mm.

Methods This was a retrospective, observational study over 22 months. Records were analysed to identify polyp resections >20 mm. Data regarding size, location, details of prophylactic therapy and use of concurrent anticoagulant/antiplatelet use were collected. Admissions for delayed bleeding were measured over a 30-day period.

Results 226 patients underwent colonoscopy with 266 polyp resections > 20mm. Anticoagulation was present in 30 patients (13.3%) and antiplatelet drugs in 58 patients (25.7%). EndoClot was applied in 25 resections with delayed bleeding in 1 patient (4%). Mechanical clips were used in 78 lesions with 8 incidents of delayed bleeding in this cohort (10.3%). We did not use any prophylactic therapy in 111 patients with no PPH. There were 13 patients with polyps > 50mm. 12 received prophylactic therapy with only 1 incidence of delayed bleeding. Detailed results are shown below.

Tab. 1 Detailed Results

	Endoclot (n=25)	Clips (n=78)	Other eg: coagulation/Purastat (n=52)	None (n=111)
Location (proximal, distal, rectal)	88% (22); 4% (1); 8% (2)	64.1% (50); 24.4% (19); 11.5% (9)	59.6% (31); 28.8% (15); 11.5% (6)	82.9% (92); 14.4% (16); 2.7% (3)
Anticoagulants	DOAC 16% (4)	DOAC 14.1% (11); Warfarin 1.3% (1)	DOAC 1.9% (1); Warfarin 1.9% (1); Clexane 3.8% (2)	DOAC 7.2% (8); Warfarin 1.8% (2)
Antiplatelets	Aspirin 24% (6); Clopidogrel 0%	Aspirin 14.1% (11); Clopidogrel 6.4% (5)	Aspirin 25% (13); Clopidogrel 1.9% (1); DAPT 1.9% (1)	Aspirin 17.1% (19); Clopidogrel 1.8% (2)
PPH	4% (1)	10.3% (8)	7.7% (4)	0%

Conclusions In our high-risk cohort, prophylactic use of EndoClot and clips suggests lower PPH with the topical haemostat. A larger number had clips used in the distal colon and were on anticoagulation. Our study was limited by its retrospective design and choice of prophylaxis based on clinician preference. Prospective data is required to identify an ideal subset of patients where topical therapy would be beneficial.