Abstract
Backgrounds. The efficacy of clipping for preventing the delayed bleeding after the removal of colon polyps is still controversial. In order to clarify this efficacy, a randomized controlled study was performed. Methods. One hundred and fifty-six patients with colon neoplasms (288 lesions) were enrolled in the study. The patients were randomly divided into two groups: clipping or nonclipping groups using a sealed envelope method before the endoscopic resections. Eight specialists and nine residents were invited to perform this procedure. The risk factors and the rates of delayed bleeding after the endoscopic resections in each group were investigated. Results. There were no significant differences in the bleeding rate between the clipping and nonclipping groups, while the length of the procedure was significantly longer and the cost was higher in the clipping group than in the nonclipping group. The rate of bleeding was significantly higher in cases with polyps 2 cm or larger and with a longer procedure time, while none of the other factors affected the bleeding rate. Conclusions. This randomized controlled study revealed no significant effect of prophylactic clipping for preventing delayed bleeding after the endoscopic resection of colon polyps.
Highlights
The most common major complication of endoscopic resection for colon polyps, including polypectomy and endoscopic mucosal resection (EMR), is bleeding [1,2,3,4,5,6,7]
The additional cost of the clipping group was 2793 yen per lesion. This randomized controlled study compared the rates of delayed bleeding after endoscopic resection between the clipping and nonclipping groups and revealed that prophylactic clipping had no significant effect in preventing the occurrence of delayed bleeding, the performance of such prophylactic clipping was a time-consuming procedure that cost about 2,553 yen extra for each case
The necessity of the prophylactic clipping after endoscopic resection has been empirically judged by individual physicians or institutes, because the indications for the procedure have not been established
Summary
The most common major complication of endoscopic resection for colon polyps, including polypectomy and endoscopic mucosal resection (EMR), is bleeding [1,2,3,4,5,6,7]. Several large retrospective studies reported contrasting results; all showed prophylactic clipping to be beneficial for preventing the delayed bleeding due to endoscopic resections [24,25,26,27]. One study investigated the bleeding rate of groups treated with and without clipping to prevent the delayed bleeding after the resection of colon polyps in 2003 and found no beneficial effects of the clipping with regard to the delayed bleeding [28]. Another prospective study, which included only cases with pedunculated polyps larger than 10 mm and in which
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