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Clipping prevents perforation in large, flat polyps.

Daniel Luba1, Mona Raphael1, Dayna Zimmerman1

  • 1Daniel Luba, James DiSario, Monterey Bay Gastroenterology Consultants, Monterey, CA 93940, United States.

World Journal of Gastrointestinal Endoscopy
|April 1, 2017
PubMed
Summary

Prophylactic clipping of large, flat, right-sided polyps after endoscopic mucosal resection significantly reduces perforation rates. This technique is crucial for preventing complications during colonoscopies.

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Area of Science:

  • Gastroenterology
  • Endoscopic Procedures
  • Colorectal Surgery

Background:

  • Endoscopic mucosal resection (EMR) is a common technique for removing large polyps.
  • Large, flat, right-sided polyps pose a higher risk of perforation after EMR.
  • Current guidelines do not uniformly recommend prophylactic closure of EMR defects.

Purpose of the Study:

  • To evaluate the efficacy of prophylactic clipping in preventing perforations after EMR of large, flat, right-sided polyps.
  • To compare perforation rates between EMR with and without prophylactic defect closure.

Main Methods:

  • A two-phase study involving colonoscopies performed between January 2010 and March 2014.
  • Phase 1: EMR of large, flat, right-sided polyps (≥1.2 cm) with clipping at endoscopist's discretion.
Keywords:
ClippingComplicationsEndoscopic mucosal resectionFlat polypsPerforationPolypectomyPrevalence

Related Experiment Videos

  • Phase 2: Prophylactic closure of all EMR defects using resolution clips.

    • Main Results:

    • Phase 1: 4 perforations (4.2%) occurred in 95 polypectomies of large polyps (1.5-2.5 cm).
    • Phase 2: No perforations occurred in 151 EMRs with prophylactic clipping (P = 0.0016).
    • No post-polypectomy hemorrhages were observed in either phase.

    Conclusions:

    • Prophylactic clipping of EMR defects for large, right-sided, flat polyps effectively reduces perforation incidence.
    • This technique enhances patient safety during endoscopic mucosal resection.
    • Routine prophylactic clipping should be considered for high-risk EMR defects.