Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate postpolypectomy bleeding

Soh, Jae Seung; Seo, Myung-Ji; Kim, Kyung‐Jo

doi:10.1186/s12876-020-01210-5

Cited by 18 publications

(19 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Though The application of prophylactic clips could reduce the incidence of PPB [5,7], Douglas K [8] pointed out that multiple adverse events, including bleeding, thermal injury and positive resection margins, should be synchronously considered in pedunculated polyp polypectomy. The application of prophylactic clips may make the resection di cult to get close to the polyp base, thus leading to positive resection margins.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Underwater endoscopic mucosal resection for 10-20 mm pedunculated colorectal polyps: a prospective pilot study

Gao

Zheng

Liu

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: The prophylactic application of clips for large pedunculated colorectal polyp resection may prevent postpolypectomy bleeding (PPB) but carries the risk of tumor remnants. This study assessed the effectiveness and safety of underwater endoscopic mucosal resection (UEMR) without clips before resecting large pedunculated polyps.Methods: Pedunculated polyps with a head diameter of 10-20 mm, a stalk diameter of ≥ 5 mm and a stalk length of ≥ 10 mm were eligible for inclusion and removed by UEMR without prophylactically clipping stem. The primary outcome was the rate of PPB, which included immediate PPB (IPPB) and delayed PPB (DPPB). The secondary outcomes included the rate of en bloc resection, complete resection, R0 resection and other adverse events.Results: Totally, 28 patients with 32 polyps were included in this study. The head diameter was 14.6 ± 3.5 mm. After polypectomy, two cases (6.3%) of nonactive spurting IPPB were observed, and no DPPB occurred during the follow-up period. All pedunculated polyps were successfully resected and achieved en bloc resection, complete resection and R0 resection. None of the polyps showed evidence of other severe adverse events.Conclusion: UEMR without the application of prophylactic clips has a low postpolypectomy bleeding rate and low risk of residual tumor and other severe adverse events. Therefore, it might be suitable and safe for resection of 10-20 mm pedunculated polyps.Trial registration: The study was registered on 08/04/2021 at ClinicalTrials.gov (NCT04837690).

show abstract

Section: Discussionmentioning

confidence: 99%

“…The application of prophylactic clips before snare polypectomy has been shown to reduce PPB and immediate postpolypectomy bleeding (IPPB) for large pedunculated polyps [5][6][7]. However, the existence of endoclips hinders resection near the base of the stem, which might lead to a high risk of tumor remnants [8].…”

Section: Introductionmentioning

confidence: 99%

Underwater endoscopic mucosal resection for 10-20 mm pedunculated colorectal polyps: a prospective pilot study

Gao

Zheng

Liu

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous studies have shown that the morphology of polyp is one of an important factor related to the complications of a colonoscopy resection of polyps [20]. Examples include Yamada type III polyps (those with short pedicles), regarding mucosal burns and perforation during resection; large polyps that contain large blood vessels in the pedicle that can cause bleeding after the endoscopic resection of colorectal polyps; and delayed bleeding [5,20]. Therefore, the pedicle of polyps needed to be evaluated in detail before colonoscopy for accurate evaluations of Yamada classi ed.…”

Section: Discussionmentioning

confidence: 99%

The Value of Colorectal Filling Contrast Ultrasonography in Diagnosing Paediatric Juvenile Polyps

Zhang

Lin

et al. 2021

Preprint

View full text Add to dashboard Cite

Objectives: To describe a facilitated procedure of colorectal filling contrast ultrasonography (CFCUS) and investigate its potential role in the assessment of paediatric juvenile polyps. Methods: The general information, clinical symptoms, ultrasound image characteristics, and colonoscopy findings of 101 children with clinical signs of colorectal polyps admitted to our hospital between May 2018 and May 2021 were retrospectively reviewed. All children underwent conventional transabdominal ultrasonography (CTUS), and CFCUS before colonoscopy, and the latter served as the gold standard. Chi-squared tests and Mann-Whitney U tests were used for the statistical analysis. Results: Forty-five children with fifty-two colorectal polyps were diagnosed by colonoscopy. Ten polyps had false-negative results on CTUS, six of which were detected by CFCUS. The sensitivity, specificity, positive predictive value, and negative predictive value of CFCUS vs CTUS was 92.3% vs 80.7%, 100% vs 100%, 100% vs 100%, 93.3% vs 84.8%, respectively. The maximum diameter of polyps (mean ± standard deviation) missed by CTUS was significantly smaller than that detected by CTUS (7.50±2.12 mm [range 4–12 mm] vs. 19.62±7.89 mm [range 6–41 mm], P<0.0001). A significant difference was observed between CTUS and CFCUS. The difference between CTUS and CFCUS regarding the detection rate of polyps with a diameter < 1 cm (P=0.031). A statistical difference was observed in the detection rate of polyps (P=0.031), and pedicles (P<0.001) between CTUS and CFCUS. The Kappa values for the assessment of Yamada’s classification between CTUS and colonoscopy and CFCUS and colonoscopy were 0.51 and 0.84, respectively. Six colonic polyps were accompanied by a punctate hyperechoic area on the surface, which may be suggestive of a correlation with erosion and bleeding findings.Conclusion: CFCUS can increase the detection rate of polyps and pedicles, especially polyps with diameters <1 cm, and accurately evaluate Yamada’s classification, providing useful preoperative information for colonoscopy.

show abstract

“…However, no clinical studies comparing DPPB between CSP with or without clip placement. Additionally, although some reports have found no DPPB after CSP, this event still occurs under real-world clinical conditions, and whether prophylactic placement of clips is effective for preventing DPPB remains controversial [15][16][17][18]. Furthermore, no reports have clari ed whether DPPB can be prevented by post-resection irrigation and inspection of the mucosal defect in the resection stump [19,20], or by checking for complete hemostasis after polypectomy, although both steps are considered effective.…”

Section: Backgroudmentioning

confidence: 99%

Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection

Okugawa

Oshima

Nakai

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The frequency of delayed bleeding after colorectal polypectomy has been reported as 0.6 – 2.8%. With the increasing performance of polypectomy under continuous use of antithrombotic agents, care is required regarding delayed post-polypectomy bleeding. Better instruction to educate endoscopists is therefore needed. We aimed to evaluate the effect of instruction and factors associated with delayed bleeding after endoscopic colorectal polyp resection.Methods: This single-center, retrospective study was performed to assess instruction in checking complete hemostasis and risk factors for onset of delayed post-polypectomy bleeding. The incidence of delayed bleeding, comorbidities, and medications were evaluated from medical records. Characteristics of patients before and after instruction were compared. Univariate analysis and forward stepwise logistic regression analysis were performed to test the influence of factors in association with delayed post-polypectomy bleeding.Results: A total of 3318 polyps in 1002 patients were evaluated. The before-instruction group comprised 1479 polyps in 458 patients and the after-instruction group comprised 1839 polyps in 544 patients. Polyp size, pedunculated type, polyp location, and rate of cold snare polypectomy did not differ between before and after instruction. Clip placement was significantly more common after instruction (22.6%, 416/1839) than before (9.7%, 144/1479, P < 0.01). Delayed post-polypectomy bleeding occurred in 1.1% of cases before instruction, and 0.4% after instruction. Instruction significantly decreased delayed bleeding, particularly in cases with antithrombotic agents. Multivariate logistic regression analysis showed that hot polypectomy, clip placement, and use of antithrombotic agents were significant independent risk factors for delayed post-polypectomy bleeding even after instruction.Conclusion: The rate of delayed bleeding significantly decreased after instruction to check for complete hemostasis. Even after instruction, delayed bleeding can still occur in cases with antithrombotic agents or hot polypectomy.

show abstract

Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate postpolypectomy bleeding

Cited by 18 publications

References 33 publications

Underwater endoscopic mucosal resection for 10-20 mm pedunculated colorectal polyps: a prospective pilot study

Underwater endoscopic mucosal resection for 10-20 mm pedunculated colorectal polyps: a prospective pilot study

The Value of Colorectal Filling Contrast Ultrasonography in Diagnosing Paediatric Juvenile Polyps

Effect of Instruction on Preventing Delayed Bleeding After Colorectal Polypectomy and Endoscopic Mucosal Resection

Contact Info

Product

Resources

About