283 Too Few or Too Many Endoclips to Close Polypectomy Defect After Endoscopic Mucosal Resection?

Abstract

Listen

Translate article

INTRODUCTION: Endoclips could be placed prophylactically at the polypectomy site after the removal of large polyps to prevent post-polypectomy bleeding. The effect of an increased number of endoclips deployed after endoscopic mucosal resection (EMR) on polyp recurrence is unknown. AIMS: Evaluate the risk of polyp recurrence in patients with large polyps undergoing EMR based on the number of endocips deployed. METHODS: We identified all patients with documented large colon polyps treated using EMR technique at Carilion Clinic, Roanoke between 01/01/2014–12/31/2017, with follow-up through 10-2018. Information on demographics, clinical and pathological features of high-risk polyps, additional treatments required, number of endoclips used, and number and timing of surveillance endoscopies were extracted. The cumulative risks of polyp recurrence after first resection using EMR technique were estimated using Kaplan-Meier curves. RESULTS: One-hundred and thirty patients (Mean age, 64.2 ± 10.7 yrs; 43.1% males) with polyps removed using EMR (60 (46.2%) removed in piecemeal fashion, 70 (53.8%) removed en bloc) were identified. The mean size of polyps resected was 2.12 ± 1.12. Argon plasma coagulation and/or the tip of the snare were used to cauterize remnant polyps in 42/130 (32%). Eighty-six patients (66.2%) required endoclips deployment to close the polypectomy defect (Table 1). At follow-up endoscopy, 14/53 (26.4%) in group 1 and 14/33 (42.4%) in group 2 developed polyp recurrence at the polypectomy site within a median of 5.9 months. The median time for recurrence after polypectomy was longer for pts in group 1 as compared to those in group 2 (P < 0.01) (Figure 1). After excluding patients receiving cauterization of the remaining polypoid tissue after EMR, median time for recurrence after polypectomy remained longer for pts in group 1 (P = 0.03) (Figure 2). Late post-polypectomy bleeding occurred despite endoclips deployment in 2/53 (3.8%) in group 1 and 4/33 (12.1%) in group 2. CONCLUSION: Large polyps EMR appear to be associated with higher recurrence rate in lesions requiring more than three endoclips. These findings need to be confirmed in prospective trials.