Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy.
BACKGROUND
The most common major complication of colonoscopic polypectomy is postpolypectomy hemorrhage. Although several factors have been implicated in the occurrence of hemorrhage, accurate prediction of delayed bleeding remains difficult. This randomized controlled trial evaluated the efficacy of prophylactic clip application for prevention of delayed postpolypectomy bleeding.


METHODS
Postpolypectomy ulcers created by colonoscopic removal of polyps (mean size 7.8 [4.0] mm) with the endoscopic mucosal resection technique were randomly assigned to prophylactic clip placement (n = 205) or no clip (n = 208). Baseline characteristics of the patients and polyps excised were comparable between the groups. Delayed bleeding was defined as the postprocedure passage of bloody stool or massive hematochezia. The site of delayed bleeding was identified at emergent colonoscopy.


RESULTS
Delayed bleeding was identified from 2 ulcers in each group from 1 to 4 days after resection (mean 2.3 days). Delayed bleeding occurred from 0.98% of ulcers in the clip group and 0.96% in the non-clip group (p > 0.9999). No patient with delayed bleeding required transfusion or surgery.


CONCLUSIONS
Prophylactic clip placement did not decrease the occurrence of delayed bleeding after colonoscopic polypectomy.
Shioji
Kazuhiko
K
The Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Suzuki
Yutaka
Y
Kobayashi
Masaaki
M
Nakamura
Atsuo
A
Azumaya
Masaki
M
Takeuchi
Manabu
M
Baba
Youichiro
Y
Honma
Terasu
T
Narisawa
Rintaro
R
D000230:Adenocarcinoma / Q000601:surgery; D018253:Adenoma, Villous / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies