Su1647 Cost-Effectiveness of Prophylactic Clipping After Colorectal Endoscopic Mucosal Resection and Economic Impact According to a Bleeding Risk Score

Albéniz, Eduardo; González, M. Fraile; Martı́nez-Ares, David; Alonso, Pedro; Guarner–Argente, Carlos; Múgica, Fernando; Cobian, Julyssa; Herreros–de–Tejada, Alberto; García, José Santiago; Álvarez-González, Marco A.; Rincón, O Nogales; Zabala, Felipe Ramos; Soto, Santiago; Espino, David R. Remedios; Ripa, Alba Zúñiga; Pardeiro, M. Remedios; Valdivielso, Eduardo; Huelín, Patrícia; Gargallo, Carla J.; Cerezo, Eduardo Redondo; Martínez-Cara, Juan Gabriel; Pellisé, María; Sánchez, Lidia Martínez; Rodríguez-Téllez, Manuel; Rodríguez-Sánchez, Joaquín; Viedma, Bartolomé López; López-Rosés, Leopoldo; Peña, Joaquín de la; Saperas, Esteban; León, Francisco Javier Navajas; Ono, Akiko; Alberca, Fernando; Pérez-Roldán, Francisco; Eguaras, J; Vila, Juan J.

doi:10.1016/j.gie.2016.03.961

Cited by 2 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cost-effectiveness analysis. Some studies have predicted cost-effectiveness of PC based on economic models [37,38]. We will analyze costeffectiveness based on healthcare utility questionnaires and clinical data.…”

Section: Discussionmentioning

confidence: 99%

Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Turan¹,

Moons

Schreuder

et al. 2021

Trials

View full text Add to dashboard Cite

Background Endoscopic mucosal resection (EMR) for large colorectal polyps is in most cases the preferred treatment to prevent progression to colorectal carcinoma. The most common complication after EMR is delayed bleeding, occurring in 7% overall and in approximately 10% of polyps ≥ 2 cm in the proximal colon. Previous research has suggested that prophylactic clipping of the mucosal defect after EMR may reduce the incidence of delayed bleeding in polyps with a high bleeding risk. Methods The CLIPPER trial is a multicenter, parallel-group, single blinded, randomized controlled superiority study. A total of 356 patients undergoing EMR for large (≥ 2 cm) non-pedunculated polyps in the proximal colon will be included and randomized to the clip group or the control group. Prophylactic clipping will be performed in the intervention group to close the resection defect after the EMR with a distance of < 1 cm between the clips. Primary outcome is delayed bleeding within 30 days after EMR. Secondary outcomes are recurrent or residual polyps and clip artifacts during surveillance colonoscopy after 6 months, as well as cost-effectiveness of prophylactic clipping and severity of delayed bleeding. Discussion The CLIPPER trial is a pragmatic study performed in the Netherlands and is powered to determine the real-time efficacy and cost-effectiveness of prophylactic clipping after EMR of proximal colon polyps ≥ 2 cm in the Netherlands. This study will also generate new data on the achievability of complete closure and the effects of clip placement on scar surveillance after EMR, in order to further promote the debate on the role of prophylactic clipping in everyday clinical practice. Trial registration ClinicalTrials.gov NCT03309683. Registered on 13 October 2017. Start recruitment: 05 March 2018. Planned completion of recruitment: 31 August 2021.

show abstract

Section: Discussionmentioning

confidence: 99%

Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Turan¹,

Moons

Schreuder

et al. 2021

Trials

View full text Add to dashboard Cite

show abstract

Prophylactic Endoscopic Clipping Does Not Prevent Delayed Postpolypectomy Bleeding in Routine Clinical Practice: A Propensity Score–Matched Cohort Study

et al. 2020

View full text Add to dashboard Cite

Introduction: Delayed postpolypectomy bleeding (DPPB) is a relatively common adverse event. Evidence is conflicting on the efficacy of prophylactic clipping to prevent DPPB, and real-world effectiveness data are lacking. We aimed to determine the effectiveness of prophylactic clipping in preventing DPPB in a large screening-related cohort. METHODS: We manually reviewed records of patients who underwent polypectomy from 2008 to 2014 at a screening facility. Endoscopist-, patient- and polyp-related data were collected. The primary outcome was DPPB within 30 days. All unplanned healthcare visits were reviewed; DPPB cases were adjudicated by committee using a criterion-based lexicon. Multivariable logistic regression was performed, yielding adjusted odds ratios (AORs) for the association between clipping and DPPB. Secondary analyses were performed on procedures where one polyp was removed, in addition to propensity score–matched and subgroup analyses. RESULTS: In total, 8,366 colonoscopies involving polypectomy were analyzed, yielding 95 DPPB events. Prophylactic clipping was not associated with reduced DPPB (AOR 1.27; 0.83–1.96). These findings were similar in the single-polyp cohort (n = 3,369, AOR 1.07; 0.50–2.31). In patients with one proximal polyp ≥20 mm removed, there was a nonsignificant AOR with clipping of 0.55 (0.10–2.66). Clipping was not associated with a protective benefit in the propensity score–matched or other subgroup analyses. DISCUSSION: In this large cohort study, prophylactic clipping was not associated with lower DPPB rates. Endoscopists should not routinely use prophylactic clipping in most patients. Additional effectiveness and cost-effectiveness studies are required in patients with proximal lesions ≥20 mm, in whom there may be a role for prophylactic clipping.

show abstract

Su1647 Cost-Effectiveness of Prophylactic Clipping After Colorectal Endoscopic Mucosal Resection and Economic Impact According to a Bleeding Risk Score

Cited by 2 publications

References 0 publications

Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Prophylactic Endoscopic Clipping Does Not Prevent Delayed Postpolypectomy Bleeding in Routine Clinical Practice: A Propensity Score–Matched Cohort Study

Contact Info

Product

Resources

About