Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Prevention

Background:

• Endoscopic mucosal resection (EMR) is standard for large colorectal polyps, but delayed bleeding occurs in ~10% of large proximal colon polyps.
• Prophylactic clipping of the resection site after EMR is a potential strategy to mitigate this risk.

Purpose of the Study:

• To evaluate the efficacy and cost-effectiveness of prophylactic clipping in reducing delayed bleeding after EMR for large proximal colon polyps.
• To assess secondary outcomes including polyp recurrence, clip artifacts, and bleeding severity.

Main Methods:

• The CLIPPER trial is a multicenter, randomized controlled study involving 356 patients with large (≥2cm) non-pedunculated proximal colon polyps.
• Patients were randomized to receive prophylactic clipping of the EMR defect or standard care (control group).
• The primary outcome was delayed bleeding within 30 days post-EMR.

Main Results:

• Delayed bleeding within 30 days post-EMR was the primary outcome.
• Secondary outcomes included polyp recurrence, clip artifacts at 6-month surveillance, cost-effectiveness, and bleeding severity.

Conclusions:

• The CLIPPER trial provides data on the real-time efficacy and cost-effectiveness of prophylactic clipping for large proximal colon polyps.
• Findings will inform clinical practice regarding the role of prophylactic clipping in EMR procedures.