Multicenter randomized controlled study to assess the effect of prophylactic clipping on post‐polypectomy delayed bleeding

Matsumoto, M; Kato, Mototsugu; Oba, Koji; Abiko, Satoshi; Tsuda, Momoko; Miyamoto, Shuichi; Mizushima, Takeshi; Ono, Masayoshi; Omori, Saori; Takahashi, Masakazu; Ono, Shoko; Mabe, Katsuhiro; Nakagawa, Manabu; Nakagawa, S.; Kudo, Takahiko; Shimizu, Yuichi; Sakamoto, Naoya

doi:10.1111/den.12661

Cited by 64 publications

(55 citation statements)

References 13 publications

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“…In the present study, clips were partially or completely displaced in 15 of 27 lesions (55.6%) at the time of PPB, therefore the dislocation of clips might be one of the reasons for PPB. However, the facts that clips remained in place in almost half of the lesions with PPB in the present study, and that PPB occurrences in lesions with prophylactic clips in previous studies suggest that the procedure could not prevent PPB completely in clinical practice. Furthermore, the effect was not enough for the HB group because of the high incidence of PPB despite the procedure.…”

Section: Discussioncontrasting

confidence: 78%

“…Uninterrupted use of oral anticoagulants or discontinuing warfarin without heparin‐bridging therapy for polypectomy might have a potential to reduce PPB without increasing the risk of thromboembolic events; however, the evidence of how to manage anticoagulants for polypectomy is still scarce. Prophylactic clip closure might reduce the risk of PPB, although the efficacy of the procedure remains controversial . In the present study, clips were partially or completely displaced in 15 of 27 lesions (55.6%) at the time of PPB, therefore the dislocation of clips might be one of the reasons for PPB.…”

Section: Discussionmentioning

confidence: 56%

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Heparin‐bridging therapy is associated with a high risk of post‐polypectomy bleeding regardless of polyp size

Ishigami

Arai

Matsumura

et al. 2016

Digestive Endoscopy

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 56%

Heparin‐bridging therapy is associated with a high risk of post‐polypectomy bleeding regardless of polyp size

Ishigami

Arai

Matsumura

et al. 2016

Digestive Endoscopy

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“…Some reports described that prophylactic clipping prevent DPPB 37 38 39 . In contrast, some studies have demonstrated that there was no difference 40 41 42 43 . In this study, the HP group had a significantly larger number of clips used for closure of the mucosal defect.…”

Section: Discussionmentioning

confidence: 89%

Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis

et al. 2017

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Background and study aims Cold snare polypectomy (CSP) for small colorectal polyps has lower incidence of adverse events, especially delayed postpolypectomy bleeding (DPPB). However, few data are available on comparisons of the incidence of DPPB of CSP and hot polypectomy (HP). The aim of this study was to evaluate the incidence of DPPB after CSP and compare it with that of HP. A propensity score model was used as a secondary analysis. Patients and methods This was a retrospective cohort study conducted in a single municipal hospital. We identified 539 patients with colorectal polyps from 2 mm to 11 mm in size who underwent CSP (804 polyps in 330 patients) or HP (530 polyps in 209 patients) between July 2013 and June 2015. Results There were no cases of DPPB in the CSP group. Conversely, DPPB occurred in 4 patients (1.9 %) after HP, resulting in a significant difference between the CSP and HP groups (0.008 % vs 0 %, P = 0.02). Propensity score-matching analysis created 402 matched pairs, yielding a significantly higher DPPB rate in the HP group than CSP group (0.02 % vs 0 %, P = 0.04). However, significantly more patients in the CSP group had unclear horizontal margins that precluded assessment (83 vs 38 cases, P < 0.001). The retrieval failure rate was significantly higher in the CSP group than in the HP group (3 % vs 0.7 %, P = 0.01). Conclusions DPPB was less frequent with CSP than HP, as selected by the propensity score-matching model. Our findings indicate that CSP is recommended polypectomy in daily clinical setting. However, special care should be taken during polyp retrieval and horizontal margin assessment, and these issues could be taken into account in follow-up after CSP.

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“…Therefore, prophylactic clipping might not prevent PPB. As for EMR and HP, it was reported that prophylactic clipping showed no efficacy for prevention of PPB [29], as was the case for CP; however, a larger number of cases is necessary to prove this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

et al. 2018

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Background: The cold polypectomy (CP) technique has been increasingly used in recent years. However, there have been few studies about post-polypectomy bleeding (PPB) in patients who underwent CP and who were on antithrombotic drugs. The objective of this study was to determine the safety of CP in patients on antithrombotic medication. Methods: The subjects were patients who underwent CP in our hospital between April 2014 and March 2016. PPB rates were examined in relation to the use of antithrombotic medication. Results: CP was performed to remove 2,466 polyps in 1,003 patients. There were 549 polyps (22.3%) in186 patients in the antithrombotic group and 1,917 polyps (77.7%) in 817 patients in the non-antithrombotic group. PPB occurred in 0.55% (3/549) of patients in the antithrombotic group and in 0.10% (2/1,917) of patients in the non-antithrombotic group, showing no significant difference (p = 0.07). Patients in the antithrombotic group in whom PPB occurred included 1 aspirin user with 1 polyp and 1 aspirin plus clopidogrel user with 2 polyps. No PPB occurred in patients on other antithrombotic agents or receiving heparin bridging. There was no significant difference between PPB rates in patients with small polyps (6–9 mm) in the antithrombotic and non-antithrombotic groups, but there was a significant difference between PPB rates in the 2 groups for patients with diminutive group (1–5 mm). Conclusion: CP is a safe procedure even in patients on antithrombotic medication.

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Multicenter randomized controlled study to assess the effect of prophylactic clipping on post‐polypectomy delayed bleeding

Cited by 64 publications

References 13 publications

Heparin‐bridging therapy is associated with a high risk of post‐polypectomy bleeding regardless of polyp size

Heparin‐bridging therapy is associated with a high risk of post‐polypectomy bleeding regardless of polyp size

Cold snare polypectomy reduced delayed postpolypectomy bleeding compared with conventional hot polypectomy: a propensity score-matching analysis

Safety of Cold Polypectomy for Colorectal Polyps in Patients on Antithrombotic Medication

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