Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: A meta‐analysis

Yang, Tsung Chieh; Wu, Yi Hui; Lee, Pei Chang; Chang, Chung Yu; Lu, Hsiao-Sheng; Chen, Yu-Jen; Huang, Yi Hsiang; Lee, Fa Yauh; Hou, Ming

doi:10.1111/jgh.15472

Cited by 11 publications

(5 citation statements)

References 50 publications

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“…A recent randomized controlled trial (RCT) [18] and several meta-analyses [19][20][21] revealed that prophylactic closure after polypectomy reduces DB in the right side of the colon. Furthermore, several retrospective studies [12,22] and a meta-analysis [23] showed the efficacy of prophylactic closure in preventing DB after colorectal ESD.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ligation with O-Ring Closure for Mucosal Defects after Rectal Endoscopic Submucosal Dissection: A Feasibility Study (with Video)

et al. 2023

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Introduction: Mucosal defect closure after colorectal endoscopic submucosal dissection (ESD) may prevent post-ESD adverse events. Delayed bleeding is a particular concern in the rectum due to the presence of numerous blood vessels. However, rectal defect closure often fails due to the thick rectal wall. This study aimed to examine the feasibility of our newly developed endoscopic ligation with O-ring closure (E-LOC) for defects after rectal ESD. Methods: This was a prospective observational study conducted at a single institution. After excluding 2 patients with tumors mostly extending into the anal canal, the study cohort comprised 30 consecutive patients who underwent ESD of rectal neoplasms between July 2020 and July 2021. E-LOC using an endoscopic variceal ligation device was performed for closing mucosal defects after rectal ESD. The primary outcome was the complete closure rate. The secondary outcomes were the delayed bleeding rate, E-LOC procedure time, sustained closure rates on postoperative day (POD) 3, and E-LOC-associated complications. Results: Complete closure of the defect (median defect size 29.0 mm) was successfully achieved in 24 cases (80%). Delayed bleeding occurred in one case with incomplete closure (3.3%). The median E-LOC procedure time was 25.5 min (interquartile range, 20.0–30.0 min). The sustained closure rates were 83.3% (20/24) on POD 3 in the 24 cases with complete closure. No E-LOC-associated complications occurred. Discussion/Conclusions: E-LOC was feasible for defect closure after rectal ESD, and probably led to a decreased incidence of delayed bleeding.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Ligation with O-Ring Closure for Mucosal Defects after Rectal Endoscopic Submucosal Dissection: A Feasibility Study (with Video)

et al. 2023

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“…Although some data 7 , 19 , 20 presented in the literature showed no definitive advantages of clipping after EMR for preventing PDB, especially for removal of 6–9 mm polyps. Lots of studies 5 , 21 – 25 showed that clip closure after EMR of large colorectal lesions is cost effective, especially in patients with a high risk of bleeding. Besides, complete closure of mucosal defect showed superior efficacy in preventing PDB compared with partial closure.…”

Section: Discussionmentioning

confidence: 99%

Clip-assisted endoloop ligation of the mucosal defect after resection of colorectal polyps decreased postprocedural delayed bleeding

Gao

Zhou

et al. 2022

Therap Adv Gastroenterol

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Background: Postprocedural delayed bleeding (PDB) remains the most common major complication of colorectal polypectomy. Incomplete clip closure of mucosal defect and unclosed injured blood vessels in gaps between clips may be the risk factors for PDB. Objectives: To observe whether completely no-gap closure of mucosal defect after polypectomy can reduce PDB occurrence. Design: Single-center, retrospective case-control study. Methods: In this study based on historical comparisons of patients in 2 time periods, only the patients with polyps sized between 6 and 15 mm were included. A new clip-assisted endoloop ligation (CAEL, treatment group) method was used between January 2019 and December 2020, and a traditional simple clip closure (SCC, control) was used Between January 2017 and December 2018 to prevent PDB after polypectomy. The rate of PDB of two groups and risk factors for PDB were evaluated. Results: Totally 4560 patients were included in the study; 2418 patients belong to CAEL group, and 2142 patients belong to SCC group. The overall rate of PDB was significantly lower in CAEL group compared to SCC group (0.6% versus 1.5%, p < 0.00). On multivariate logistic analysis, CAEL was a significant independent preventive factor for PDB (odds ratio (OR), 0.092; 95% confidence interval (CI), 0.029–0.3335; p = 0.000). Polyps located at rectum (colon versus rectum) represented a significant independent risk factor for PDB (OR, 11.888; 95% CI, 3.343–42.269; p = 0.001). Conclusion: Completely no-gap closure of mucosal defect after polypectomy further reduced the rate of PDB for polyps sized between 6 and 15 mm. CAEL may be a significant independent preventive factor for PDB. Polyps located at the rectum may be a significant independent risk factor for PDB.

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“…hemoclips or coagulation forceps). Furthermore, prophylactic use of clips was known to decrease delayed bleeding 34,35 …”

Section: Discussionmentioning

confidence: 99%

Comparison of precutting endoscopic mucosal resection and endoscopic submucosal dissection for large (20–30 mm) flat colorectal lesions

Cho

Choi

et al. 2021

J of Gastro and Hepatol

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Background and Aim The complete and safe removal of large (≥ 20 mm) colorectal lesions is an area of concern. Endoscopic submucosal dissection (ESD) effectively removes these lesions compared with endoscopic mucosal resection (EMR). However, ESD requires advanced techniques, longer procedure time, and high cost. Precutting EMR (EMR‐P) is a modified EMR method that overcomes the limitations of EMR. This study aimed to compare the efficacy and safety of EMR‐P and ESD in large (20–30 mm) flat colorectal lesions. Methods This was a retrospective analysis of cases in which 20‐ to 30‐mm flat colorectal lesions were resected at Seoul St. Mary's Hospital from January 2014 to December 2019. Propensity score matching was performed to control for possible confounders. Results Two hundred and ninety‐nine patients were included in this study. After matching, 90 patients were assigned to each group. There were no significant difference in complete resection rates (92.2% vs 92.2%, P = 1.000), en bloc resection rates (95.6% vs 97.8%, P = 0.682), and mean size of lesions (22.9 ± 3.1 mm vs 23.0 ± 3.1 mm, P = 0.867) between EMR‐P and ESD. Procedure time was significantly shorter with EMR‐P (11.0 ± 6.5 min vs 37.0 ± 19.3 min, P < 0.001). The adverse events rate was not significantly different between both groups. No local recurrence occurred in both groups. Conclusions Precutting EMR was not significantly different to ESD in terms of complete resection rate and en bloc resection rate for 20‐ to 30‐mm flat colorectal lesions without fibrosis. Furthermore, EMR‐P has shorter procedure time than ESD. EMR‐P could be considered one of standard treatments for large flat colorectal lesions.

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Prophylactic clipping after endoscopic mucosal resection of large nonpedunculated colorectal lesions: A meta‐analysis

Cited by 11 publications

References 50 publications

Endoscopic Ligation with O-Ring Closure for Mucosal Defects after Rectal Endoscopic Submucosal Dissection: A Feasibility Study (with Video)

Endoscopic Ligation with O-Ring Closure for Mucosal Defects after Rectal Endoscopic Submucosal Dissection: A Feasibility Study (with Video)

Clip-assisted endoloop ligation of the mucosal defect after resection of colorectal polyps decreased postprocedural delayed bleeding

Comparison of precutting endoscopic mucosal resection and endoscopic submucosal dissection for large (20–30 mm) flat colorectal lesions

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