Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events

Abstract

Clip closure of large colorectal mucosal defects may reduce the rate of adverse events in a cost-effective manner. To assess the adverse events and outcomes of clip closure of defects after endoscopic resection in patients with large colorectal tumors. Prospective, randomized, controlled study. Single tertiary referral center. Patients with lesions measuring 1 to 4 cm who were scheduled for endoscopic resection between March 2012 and December 2014 were randomly assigned to a clip-closure group and a no-closure group. In the clip-closure group, the defect of the resection site was completely closed with an endoclip. In the no-closure group, the defect was left open. The following primary outcome measures were assessed: delayed postoperative bleeding, postpolypectomy coagulation syndrome, perforation, and abdominal pain. Secondary outcome measures of length of hospital stay, time required for procedure, and patient's satisfaction were also assessed. Patients and lesions had similar characteristics across both groups. For patients who underwent clip closure (n= 174), the rates of delayed postoperative bleeding (1.1% [2/174]) and postpolypectomy coagulation syndrome (0.6% [1/174]) were lower than those in the no-closure group (6.9% [12/174], P= .01 and 4.6% [8/174], P= .03). Two patients experienced perforation, 1 in each group. In the clip-closure group, 4 patients reported abdominal pain as opposed to 26 in the no-closure group (2.8% vs 16.7%, P< .01). The procedure took longer in the closure group (38.1 minutes vs 30.9 minutes, P= .04). The length of hospitalization was shorter in the closure group (3.1 days vs 4.7 days, P= .03). Total medical expense was similar between the 2 groups. Patients who underwent closure reported greater satisfaction. This was a single-center analysis. Clip closure of endoscopic resection defects in patients with large colorectal tumors decreased the rate of procedure-related adverse events and did not increase the cost of hospitalization.