Stalk Injection and Prophylactic Clipping of Pedunculated Polyps Increase Delayed Bleeding
Douglas K. Rex, MD, MASGE, reviewing Tagawa T, et al. Gastrointest Endosc 2021 Apr 12.
In this Japanese study from 5 institutions, 1147 pedunculated (stalk length of ≥5 mm) colorectal polyps were evaluated for predictors of immediate bleeding after being removed by Endo Cut (Erbe Elektromedizin GmbH, Tuebingen, Germany) or forced coagulation current. Overall, immediate bleeding occurred in 8.5% of polypectomies, and the all-important delayed bleeding occurred in 2% of polypectomies. For polyps ≥15 mm in size, Endoloop (Ethicon, Somerville, NJ) reduced the risk of immediate bleeding by 83% but did not prevent delayed bleeding. Prophylactic clipping before polypectomy (odds ratio [OR], 4.2) and injecting the stalk (OR, 4.0) actually increased the risk of delayed bleeding. Placement of clips on the resection site after polyp removal was not associated with a reduced risk of delayed bleeding.
COMMENTSome previous data indicate that prophylactic clipping of stalks increases the risk of thermal injury to the colon wall. This retrospective study suggests prophylactic clipping before transection is actually dangerous, though some risk of selection bias in a retrospective study is always present. My preference is to cut the stalk of pedunculated polyps close to the wall, using forced coagulation current to maximize the distance between any cancer that may be present and the resection margin, and place clips on the site after resection. However, this study casts doubt on the effectiveness of postresection site clipping.
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)
Tagawa T, Yamada M, Minagawa T, et al. Endoscopic characteristics influencing postpolypectomy bleeding in consecutive 1147 pedunculated colonic polyps: a multicenter retrospective study. Gastrointest Endosc 2021 Apr 12. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2021.03.996)
