title: Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions.
abstract: BACKGROUND
  Endoscopic resection of large colorectal lesions is associated with high complication rates.
  
  
  OBJECTIVE
  To evaluate the effect of prophylactic clip closure of polypectomy sites after resection of large (≥2 cm) sessile and flat colorectal lesions.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Patients with lesions 2 cm or larger who underwent EMR performed by using low-power coagulation current between January 2000 and February 2012. Beginning in June 2006, polypectomy sites were prophylactically closed with clips when possible. Patients had telephone follow-up at 30 days or later to track complications.
  
  
  METHODS
  Delayed hemorrhage, postpolypectomy syndrome, and perforation.
  
  
  RESULTS
  There were 524 lesions 2 cm or larger in 463 patients, of which 247 (47.1%) were not clipped, 52 (9.9%) were partially clipped, and 225 (42.9%) were fully clipped. There were 31 delayed hemorrhages, 2 perforations, and 6 cases of postpolypectomy syndrome. The delayed hemorrhage rate was 9.7% in the not clipped group versus 1.8% in the fully clipped group. Multivariate analysis showed that not clipping (odds ratio [OR] 6.0; 95% CI, 2.0-18.5), location proximal to the splenic flexure (OR 2.9; 95% CI, 1.05-8.1), and polyp size (OR 1.3; 95% CI, 1.1-1.7 for each 10-mm increase in size) were associated with delayed bleeding.
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  Prophylactic clipping of resection sites after endoscopic removal of large (≥2 cm) colorectal lesions using low-power coagulation current reduced the risk of delayed postpolypectomy hemorrhage. A randomized, prospective trial of clipping large polypectomy sites is warranted.
authors: Department of Medicine, Division of Gastroenterology, Indiana University Health, Indianapolis, IN, USA.
authors: Hammad
authors: H
authors: Liaquat
authors: Elizabeth
authors: E
authors: Rohn
authors: Douglas K
authors: DK
authors: Rex
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003108:Colonic Diseases / Q000209:etiology / Q000517:prevention & control*; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016001:Confidence Intervals; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000191:economics