Clip Closure Did Not Reduce Delayed Hemorrhage After Resection of Large Sessile Serrated Lesions Using Electrocautery, Even From the Proximal Colon
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Clip Closure Did Not Reduce Delayed Hemorrhage After Resection of Large Sessile Serrated Lesions Using Electrocautery, Even From the Proximal Colon

Douglas K. Rex, MD, MASGE, reviewing Crockett SD, et al. Clin Gastroenterol Hepatol 2021 Dec 27.

Recent large randomized controlled trials have demonstrated that clip closure reduces the risk of delayed hemorrhage after endoscopic mucosal resection (EMR) using electrocautery if the lesions are ≥20 mm and located proximal to the splenic flexure.

In a post hoc analysis of one of the pivotal trials that proved clipping is effective for preventing bleeding after EMR of proximal lesions, investigators examined the results according to polyp histology. Of 179 participants with 199 large serrated polyps, postprocedure bleeding occurred in 2.3% of the clipped lesions versus 3.3% of the controls. For the adenomas, clipping reduced postprocedure bleeding from 7.6% to 3.9% (P=.03). For proximal adenomas, the absolute risk reduction was 6.8% (P=.004).

Douglas K. Rex, MD, FASGE

COMMENT

These data further narrow the group of lesions for which prophylactic clip closure following EMR is effective in preventing delayed hemorrhage, specifically adenomas that are ≥20 mm, proximal to the splenic flexure, and removed using electrocautery. This observation is important because some centers may still use electrocautery to remove large sessile serrated lesions (SSLs). Prophylactic clipping is becoming less relevant as the movement toward cold EMR of SSLs expands since clip closure is generally unnecessary after cold EMR of any lesion.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Crockett SD, Khashab M, Rex DK, et al; Large Polyp Study Consortium. Clip closure does not reduce risk of bleeding after resection of large serrated polyps: results from a randomized trial. Clin Gastroenterol Hepatol 2021 Dec 27. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2021.12.036)

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