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Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate

Jae Seung Soh1, Myeongsook Seo2, Kyung-Jo Kim3

  • 1Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Republic of Korea.

BMC Gastroenterology
|March 14, 2020
PubMed
Summary
This summary is machine-generated.

Prophylactic clip application significantly reduces immediate postpolypectomy bleeding (PPB) in large pedunculated colorectal polyps. This technique should be considered, particularly for polyps with larger diameters and thicker stalks.

Keywords:
ClipPedunculated polypsPost-polypectomy bleeding

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Colorectal Cancer Prevention

Background:

  • Postpolypectomy bleeding (PPB) is a risk after colorectal polyp removal.
  • The efficacy of prophylactic clipping for large pedunculated polyps remains debated.
  • This study aimed to assess prophylactic clipping's effectiveness and identify PPB predictors.

Purpose of the Study:

  • To evaluate the effectiveness of prophylactic clip application in preventing PPB.
  • To identify predictors of PPB in large pedunculated colorectal polyps.

Main Methods:

  • A prospective randomized trial involving 137 large pedunculated polyps (≥1 cm) from 116 patients.
  • Polyps were randomized into two groups: prophylactic clipping (Group A) and no clipping (Group B).
  • Immediate and delayed PPB occurrences were compared between groups.

Main Results:

  • Immediate PPB occurred in 9.0% of polyps with clipping versus 31.4% without (P=0.001).
  • Prophylactic clipping significantly reduced immediate PPB risk (OR 0.215).
  • Polyp size (≥20 mm) and stalk diameter (≥4 mm) were predictors of immediate PPB.

Conclusions:

  • Prophylactic clip application is effective in reducing immediate PPB for large pedunculated polyps (≥1 cm).
  • Consider clip application before snare polypectomy, especially for large polyps with thick stalks.
  • This intervention enhances safety in endoscopic polyp resection.