Prophylactic Clipping for the Prevention of Delayed Complication After Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumor

An, Jy; Bw, Kim; Park, Joo Myun; Kim, Tae Hee; Lee, J

doi:10.1055/s-0039-1681517

Cited by 3 publications

(4 citation statements)

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“…Of these publications, 32 were excluded from our final analysis, and the reasons were listed in Figure 1. Finally, 27 studies, published between 2003 and 2020, were included in this meta-analysis 10,15–17,22–44…”

Section: Resultsmentioning

confidence: 99%

Prophylactic Clipping to Prevent Delayed Bleeding and Perforation After Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection

Jiang

Dong

Zhu

et al. 2022

Journal of Clinical Gastroenterology

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Background and Aims: To help prevent delayed adverse events after endoscopic surgery, endoscopists often place clips at the site. This meta-analysis aimed to assess the efficacy and safety of prophylactic clipping in the prevention of delayed bleeding and perforation after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). Methods: Multiple databases were searched from the inception dates to April 2021. And we included all relevant studies. Pooled odds ratio comparing the prophylactic clipped group versus nonprophylactic clipped group were calculated using the random effects model. Results: Twenty-seven articles fulfilled the inclusion criteria, with a total size of 8693 participants. There was statistically significant difference in prophylactic clipping versus no prophylactic clipping for delayed bleeding and perforation found in all studies (odds ratio: 0.35, 95% confidence interval: 0.25-0.49, P<0.01; odds ratio: 0.42, 95% confidence interval: 0.21-0.83, P<0.05; respectively). Besides, statistically significant difference was also found in subgroup analyses based on patients with lesions larger than 20 mm. Prophylactic clipping was more protective for duodenal delayed adverse events than colorectum. The use of clip closure was more protective to ESD-related delayed adverse events than EMR. Conclusions: Prophylactic clipping after ESD and EMR was beneficial in preventing delayed bleeding and perforation.

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Section: Resultsmentioning

confidence: 99%

Prophylactic Clipping to Prevent Delayed Bleeding and Perforation After Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection

Jiang

Dong

Zhu

et al. 2022

Journal of Clinical Gastroenterology

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“… 49 Moreover, the diffuse submucosal vascularization of the duodenum combined with the presence of Brunner’s glands increases the risk for bleeding complications up to 14%, hindering the lifting of the target lesions. 57 , 58 An et al 59 showed that after endoscopic resection of nonampullary superficial tumors, preventive clipping of the site was associated with a reduced incidence of delayed bleeding (2.1% vs. 13.6%; p =0.053). The usefulness of preventive clipping has been confirmed in other studies, 60 , 61 particularly for lesions that are >10 mm or with visible vessels of >2 mm 62 - 64 ; however, randomized studies are still lacking.…”

Section: Lesions Clippingmentioning

confidence: 99%

Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment

et al. 2022

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Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

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“…Delayed bleeding occurred in 1 patient (2.1%) and delayed perforation occurred in 1 patient (2.1%) within the clipping group, whereas within the non-clipping group, delayed bleeding occurred in 6 patients (13.6%, P=0.053) and delayed perforation occurred in 3 patients (6.8%, P=0.350). Therefore, prophylactic clipping showed a tendency towards lower complication rates [ 40 ]. In view of the above, for resected duodenal lesions >10 mm, the recommendation is to close the resection site using endoclips to prevent delayed bleeding and perforation [ 38 - 41 ].…”

Section: Prophylactic Use Of Endoclipsmentioning

confidence: 99%

“…In pedunculated polyps (Paris classification Ip), prophylaxis for bleeding post-polypectomy with endoclips is recommended in those in which the polyp head is ≥20 mm, or if the pedicle is ≥10 mm [ 46 , 53 ]. The American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend the prophylactic application of endoclips for resection of polyps with a pedicle greater than 5 mm [ 40 ]. ESGE guidelines also suggest the use of a diluted epinephrine injection as an alternative or in association with mechanical hemostasis in the pretreatment of polyps with a large pedicle [ 46 ].…”

Section: Prophylactic Use Of Endoclipsmentioning

confidence: 99%

Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications

Xavier

Campos

Robinson

et al. 2020

aog

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Endoscopic clipping has become a common practice among endoscopists. Several models are available, most frequently being introduced via the working channel of the endoscope (through-the-scope); however, larger clips can also be mounted onto the distal tip of the endoscope (over-the-scope). The main indications for endoclip placement include providing effective mechanical hemostasis for bleeding lesions and allowing endoscopic closure of gastrointestinal perforations. Endoclips can also be used prophylactically after endoscopic resection; however, this practice is still controversial. This review discusses the main indications for endoscopic clipping in the esophagus, stomach, duodenum and colon to manage acute bleeding lesions, and the criteria to be used in the prevention of delayed post-polypectomy bleeding.

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Prophylactic Clipping for the Prevention of Delayed Complication After Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumor

Cited by 3 publications

References 0 publications

Prophylactic Clipping to Prevent Delayed Bleeding and Perforation After Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection

Prophylactic Clipping to Prevent Delayed Bleeding and Perforation After Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection

Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment

Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications

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