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Clip Closure Does Not Reduce Risk of Bleeding After Resection of Large Serrated Polyps: Results From a Randomized
Seth D Crockett1, Mouen Khashab2, Douglas K Rex3
1Division of Gastroenterology & Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Summary
Prophylactic clipping of large serrated polyps after endoscopic mucosal resection does not reduce bleeding risk. Clipping benefits adenomatous polyps, suggesting its use should be reserved for these specific colorectal lesions.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Endoscopic Procedures
Background:
- Serrated polyps are key precursors to colorectal cancer, often found in the proximal colon where bleeding after polyp removal is more common.
- Clinical evidence guiding the resection of large serrated polyps (LSPs) is limited.
- Large serrated polyps (LSPs) are defined as those ≥20 mm in size.
Purpose of the Study:
- To evaluate the efficacy of prophylactic clipping of the resection base in reducing post-polypectomy bleeding for large serrated polyps (LSPs) compared to adenomatous polyps.
- To compare post-procedure bleeding rates between clipping and no-clipping groups for LSPs and adenomatous polyps.
Main Methods:
- A multicenter trial randomized patients with large (≥20 mm) non-pedunculated polyps undergoing endoscopic mucosal resection (EMR) to either clipping or no clipping of the resection base.
- The study stratified polyp histology into serrated (sessile serrated lesions/hyperplastic polyps) and adenomatous subtypes.
- The primary outcome measured was severe post-procedure bleeding within 30 days of colonoscopy.
Main Results:
- Among 199 LSPs (191 sessile serrated lesions, 8 hyperplastic polyps), 2.8% experienced post-procedure bleeding, with no significant difference between clipping (2.3%) and no clipping (3.3%) groups.
- In contrast, for 771 adenomatous polyps, clipping was associated with a significantly lower bleeding risk (3.9% vs. 7.6%, P=.03) and fewer serious adverse events (5.5% vs. 10.6%, P=.01).
Conclusions:
- Endoscopic mucosal resection of large serrated polyps carries a low risk of post-procedure bleeding, and prophylactic clipping offers no discernible benefit.
- The prophylactic use of endoscopic clipping following EMR appears to be beneficial primarily for large adenomatous polyps (>2 cm) in the proximal colon.
