Clip Closure After Resection of Large Colorectal Lesions With Substantial Risk of Bleeding

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Medicine

Background:

• The efficacy of clip closure for mucosal defects after colonic endoscopic mucosal resection (EMR) in preventing delayed bleeding remains unclear, especially in low-risk scenarios.
• This study focuses on large (≥2 cm) nonpedunculated colorectal lesions in patients with average or high risk of bleeding.

Purpose of the Study:

• To evaluate the effectiveness of complete clip closure in preventing delayed bleeding after EMR of large colorectal lesions.
• To assess the impact of clip closure on the incidence of delayed bleeding in patients at high risk.

Main Methods:

• A single-blind, randomized trial involving 235 patients undergoing EMR for large nonpedunculated colorectal lesions.
• Patients were randomized into two groups: complete clip closure of the scar (n=119) or no clip closure (control, n=116).
• Delayed bleeding was defined as hematochezia requiring medical intervention within 15 days post-colonoscopy.

Main Results:

• Complete clip closure was achieved in 57% of cases, with partial closure in 28% and failure in 15%.
• Delayed bleeding occurred in 12.1% of the control group versus 5% in the clip group (absolute risk reduction of 7%).
• When clip closure was complete, delayed bleeding incidence dropped to 1.5% (absolute risk reduction of 10.6%).

Conclusions:

• Clip closure of mucosal defects after EMR for large colorectal lesions in high-risk patients can be challenging but effectively reduces delayed bleeding.
• Complete clip closure is crucial for achieving the preventive effect against delayed bleeding.
• The study provides evidence for the utility of clip closure in managing bleeding risks associated with colorectal EMR.