The role of prophylactic clip application in preventing delayed post-polypectomy bleeding after resection of a colorectal polyp sized 10-25mm

Aims The routine use of prophylactic clips to prevent delayed post-polypectomy bleeding (PPB) following endoscopic mucosal resection (EMR) continues to be debated. This study aimed to evaluate the effectiveness of prophylactic clip application in reducing DPPB by comparing prospective randomized cohorts that used routine prophylactic clips with a historical control cohort that did not receive any prophylactic measures.

Methods Between December 2020 and November 2021, patients with 10-25 mm-sized colorectal polyps planning to undergo EMR were prospectively enrolled at a single academic center. They were randomly assigned to the EZ clip or Core Clip group. A historical control group with no use of prophylactic clips was identified through retrospective chart review. We compare the incidence of PPB between the groups. Immediate PPB was defined as spurting bleeding immediately following polypectomy, or oozing bleeding that lasts for more than 1 minute. The occurrence of delayed PPB was assessed on post-polypectomy day 1 and 7-14, respectively.

Results A total of 157, 158, and 167 colorectal polyps were enrolled in the no clip, EZ clip, and Core clip groups, respectively. The size of colorectal polyps was 14.1±4.5 mm, 13.5±4.3 mm, and 13.9±4.5 mm, respectively (P=0.483). Cut vessels on post-EMR ulcers were observed in 15.3%, 19.6%, and 16.2%, respectively (P=0.555). Immediate PPB occurred in 9.6%, 15.8%, and 16.2% respectively (P=0.159). Delayed PPB within 1 day of the procedure was observed in 0.6% (n=1), 1.9% (n=3) and 0.6% (n=1), respectively (P=0.427). No patient experienced PPB after post-polypectomy day 1 and there were no incidents of perforation of post-polypectomy electrocoagulation within post-polypectomy days 7-14. There were no significant differences between any two groups regarding complications, including PPB, perforation, and electrocoagulation.

Conclusions The prophylactic application of endoscopic clips may not prevent delayed post-polypectomy bleeding after resection of colorectal polyps sized 10-25 mm.

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025