title: The prophylactic placement of hemoclips to prevent delayed post-polypectomy bleeding: an unnecessary practice? A case control study.
abstract: BACKGROUND
  With the recent, widespread availability of endoscopic hemoclips, it has become common clinical practice to apply hemoclips to some non-bleeding polypectomy sites "prophylactically" to prevent delayed post-polypectomy bleeding (PPB). Few published data support this practice, however.
  
  
  OBJECTIVE
  The aim of this study was to compare rates of delayed PPB in matched patients who had polypectomies performed with and without the prophylactic placement of hemoclips.
  
  
  METHODS
  We reviewed medical records of patients who had elective colonoscopy at our VA Medical Center between July 2008 and December 2009. We identified patients who had hemoclips applied prophylactically (cases) and compared their rate of delayed PPB within 30 days to that of patients who had polypectomy without hemoclipping (controls). Controls were matched 1:1 to cases based on age and on factors known to contribute to the risk of PPB including polyp size, morphology, technique of polyp removal, number of polyps removed, and use of anticoagulants.
  
  
  RESULTS
  We identified 184 patients (cases) who underwent prophylactic hemoclipping and 184 well-matched controls. An average of 3.8 polyps per patient were removed in the case group compared to 3.3 polyps per patient in controls (p = 0.6). Delayed PPB occurred in three patients in the prophylactic hemoclip group and in one patient in the control group (1.6 vs. 0.5 %, p = 0.62).
  
  
  CONCLUSIONS
  We found no significant difference in the rate of delayed PPB between patients who had prophylactic hemoclipping of polypectomy sites and a well-matched control group of patients who had polypectomy without prophylactic hemoclipping. These data call into question the expensive practice of prophylactic hemoclipping.
authors: Division of Gastroenterology, VA North Texas Healthcare System, 4500 S. Lancaster Rd (111B1), Dallas, TX, 75216, USA, Linda.Feagins@va.gov.
authors: Linda A
authors: LA
authors: Feagins
authors: Anh D
authors: AD
authors: Nguyen
authors: Ramiz
authors: R
authors: Iqbal
authors: Stuart J
authors: SJ
authors: Spechler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D019564:Unnecessary Procedures