Prevention of Bleeding After Endoscopic Resection of Colonic Polyps: to Clip or not to Clip

Abstract

Endoscopic resection of large colonic lesions once thought only amenable to surgery is now standard treatment, but post-procedure bleeding has been common, occurring in 5–10% of patients. This review summarizes efficacy data on clip closure to reduce bleeding risk, selection of polyps, costs and limitations. Randomized control trials and meta-analysis provide strong evidence for the benefit of prophylactic clip closure to prevent bleeding after endoscopic resection of large ≥ 20-mm proximal polyps, but not for smaller polyps or for large polyps in the distal colon. Clip closure techniques need to be improved, and further research may help to better identify which patients may most benefit from prophylactic closure. Post-procedure bleeding is the most common complication after large polyp resection. Clip closure of the mucosal defect after resection of all proximal 20-mm polyps should be attempted because it reduces bleeding risk by at least half.