Randomized controlled trials demonstrate that prophylactic clip closure of endoscopic mucosal resection (EMR) defects of large (\u226520 mm) nonpedunculated colorectal lesions effectively prevents delayed hemorrhage. In a meta-analysis, the benefits were present for lesions proximal to the splenic flexure. The practice is controversial, though, because of the high cost of clips. <\/p>\n\n\n\n
In this study, the Spanish investigators who performed one of the randomized controlled trials performed a cost-effectiveness analysis to determine which lesions are cost-effective to clip. In the U.S., the accepted threshold for cost-effectiveness is an incremental cost-effectiveness ratio (ICER) of <$100,000 per quality-adjusted life-year. The analysis showed that if the delayed bleeding risk score was \u22657, according to the risk score model from the Spanish Endoscopy Society EMR Group (GSEED-RE2), the U.S. ICER was $87,796.<\/p>\n\n\n\n
The GSEED-RE2 score ranges from 0 through 9, with 1 point for comorbidity or American Society of Anesthesiologists (ASA) physical status classification of III or IV, 2 points for lesion size \u226540 mm, and 3 points each for location proximal to the splenic flexure and antiplatelet or anticoagulant agents.<\/p>\n\n\n\n
In the actual high-risk group (52% of the whole cohort), all of the patients had lesions proximal to the splenic flexure and were prescribed antiplatelets or anticoagulants, 99.2% had ASA III or IV or comorbidity, and 20.6% had a lesion size \u226540 mm.<\/p>\n","protected":false},"excerpt":{"rendered":"
Randomized controlled trials demonstrate that prophylactic clip closure of endoscopic mucosal resection (EMR) defects of large (\u226520 mm) nonpedunculated colorectal lesions effectively prevents delayed hemorrhage. In a meta-analysis, the benefits were present for lesions proximal to the splenic flexure. The practice is controversial, though, because of the high cost of clips. In this study, the … Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1768,1769],"tags":[2058,268,1832,2113,2560],"class_list":["post-9690","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan","category-asge-kolon","tag-colon-2","tag-emr","tag-endoscopic-mucosal-resection-2","tag-icer","tag-incremental-cost-effectiveness-ratio"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/9690","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=9690"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=9690"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=9690"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}