Hemoclipping for postpolypectomy and postbiopsy colonic bleeding

Parra‐Blanco, Adolfo; Kaminaga, Norihiro; Kojima, Toshihiro; Endo, Yutaka; Uragami, Naoyuki; Okawa, Nobuhiko; Hattori, Takashi; Takahashi, Hiroshi; Fujita, Rikiya

doi:10.1016/s0016-5107(00)70384-1

Cited by 161 publications

(82 citation statements)

References 20 publications

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“…As endoscopic examinations are often performed after the temporary stoppage of antithrombotic drugs, the risks of thrombosis during antithrombotic drug holidays are real (30)(31)(32), as well as bleeding after retaking the drugs (33,34). However, regardless of taking antithrombotic drugs, there is a possibility of bleeding to occur (35,36). In these previous reports, although there were serious adverse effects including anaphylactic shock and respiratory depression, there were no cases of death.…”

Section: Harms Of Endoscopic Screening For Gastric Cancermentioning

confidence: 99%

Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities

Hamashima

Fukao

2016

Jpn. J. Clin. Oncol.

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The Japanese government introduced endoscopic screening for gastric cancer in 2015 as a public policy based on the Japanese guidelines on gastric cancer screening. To provide appropriate endoscopic screening for gastric cancer in Japanese communities, we developed a quality assurance manual of endoscopic screening and recommend 10 strategies with their brief descriptions as follows: (i) Formulation of a committee responsible for implementing and managing endoscopic screening, and for deciding the suitable implementation methods in consideration of the local context; (ii) Development of an interpretation system that leads to a final judgement to standardize endoscopic examination and improve its accuracy; (iii) Preparation of management and reporting systems for adverse effects by the committee for safety management; (iv) Obtaining informed consent before operation following adequate explanations regarding the benefits and harms of endoscopic screening; (v) Avoidance of frequent screenings to reduce false-positive results and overdiagnosis. As a reference, the target age group is ≥50 years, and the screening interval is 2 years; (vi) Keeping the biopsy rate within 10% as post-biopsy bleeding may occur. Before endoscopic screening, any history of antithrombotic drug usage should be checked; (vii) Nonadministration of sedation in endoscopic screening for safety management; (viii) Adherence to proper endoscopic cleaning and disinfection to reduce infection; (ix) Use of a checklist to achieve optimal program preparation when municipal governments introduce endoscopic screening; (x) Identification of the aims and roles by referring to a checklist if primary care physicians decide to participate in endoscopic screening.

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Section: Harms Of Endoscopic Screening For Gastric Cancermentioning

confidence: 99%

Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities

Hamashima

Fukao

2016

Jpn. J. Clin. Oncol.

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“…Risk stratification for these patients can be relegated to two categories. Low risk procedures include diagnostic colonoscopy including mucosal biopsy (Sieg et al, 2001, Parra-Blanco et al, 2000) and high-risk procedures include colonoscopy with polypectomy and the dilatation of colonic benign or malignant strictures (guidelines extrapolated in part from experience reported in the upper gastrointestinal endoscopy literature) (Singh et al, 2005, Solt et al, 2003, DiSario et al, 1994. A comprehensive review of the types of antithrombotic therapies, their implications for patients undergoing colonoscopy, and recommendations and a management algorithm for such patients using these agents has recently been published (ASGE Standards of Practice Committee, 2009).…”

Section: Antithrombotic Agents In Patients Undergoing Colonoscopymentioning

confidence: 99%

Introduction - A Brief Overview of Selected Aspects of Colonoscopy: Past, Present and Future

Miskovitz¹

2011

Colonoscopy

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“…[14][15][16][17][18][19] PPH is more common in larger polyps. 17,18 Techniques like adrenaline injection 20 or mechanical haemostasis 21 are effective in controlling immediate PPH and are widely used.…”

Section: Introductionmentioning

confidence: 99%

Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta‐analysis

et al. 2014

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Background and aim: Postpolypectomy haemorrhage (PPH) is a known adverse event that can occur following polypectomy, occurring in 0.3-6.1% of cases. Previous meta-analysis has included small polyps, which are less likely to bleed, and less amenable to some methods of mechanical haemostasis. No comprehensive cost-benefit analysis of this topic is available. The aim of this study was to perform a meta-analysis of randomized trials and a cost-benefit analysis of prophylactic haemostasis in PPH. Methods: A total of 3092 abstracts from prospective trials conducted in human colonoscopic polypectomy were screened. Outpatients undergoing polypectomy in seven suitable studies (1426 episodes), without polyposis syndromes or bleeding diathesis, were identified. The interventions of prophylactic haemostatic measures (clips, loops, and/or adrenaline injection) to prevent PPH were assessed. The main outcome measurements were PPH measured by haematochezia or drop in haematocrit >10% or haemoglobin >1 g/dl. Risk ratio and number needed to treat (NNT) were generated using metaanalysis. Results: Comparing any prophylactic haemostasis to none, the pooled risk ratio for PPH was 0.35 (0.21-0.57; p < 0.0001), NNT was 13.6, and cost to prevent one PPH was USD652. Using adrenaline alone vs. no prophylactic haemostasis revealed a pooled risk ratio of 0.37 (0.20-0.66; p ¼ 0.001), NNT 14.0, cost to prevent one PPH USD382. Any prophylactic mechanical haemostasis compared to adrenaline produced a RR for PPH of 0.28 (0.14-0.57; p < 0.0001), NNT 12.3, and cost to prevent one PPH USD1368. Conclusions: Adrenaline injection or mechanical haemostasis reduces the risk of PPH. Routine prophylactic measures to reduce PPH for polyps larger than 10 mm are potentially cost effective, although more thorough cost-benefit modelling is required.

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Hemoclipping for postpolypectomy and postbiopsy colonic bleeding

Cited by 161 publications

References 20 publications

Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities

Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities

Introduction - A Brief Overview of Selected Aspects of Colonoscopy: Past, Present and Future

Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta‐analysis

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