Preventive effect of endoclip and endoloop on post-polypectomy bleeding of large colorectal polyps and literature review

Abstract

Objective To investigate the preventive effect of endoclips and endoloops on post-polypectomy bleeding of large colorectal polyps. Methods Data of patients, who underwent polypectomy during January 2013 to March 2016, were retrospectively collected. The diameters of all polyps were more than 10 mm. Cases were divided into 4 groups. Before large pedunculated (with thick stalks) polyps were resected, endoclips were used to ligate the pedicles of polyps in Group A, and endoloops were used in Group B. After large sessile and pedunculated (without thick stalks) polyps were resected, endoclips were used to close the incision of polypectomy in Group C, but not in Group D. The immediate and delayed post-polypectomy bleeding rate and clinicopathologic features were studied. Articles about endoclip or endoloop on preventing post-polypectomy bleeding in PubMed in last five years were searched and analyzed. Results A total of 2 006 polyps were included. The immediate bleeding rate was 3.4% (5/147) and 3.8% (5/132) of Group A and B, respectively. The delayed bleeding rate was 6.1% (9/147) and 7.6% (10/132) of Group A and B, respectively. The delayed bleeding rate of Group C and D was 3.2% (28/888) and 1.9%(16/839), respectively. None of the bleeding cases needed a surgical operation. And no perforation occurred. Six articles were included for analysis. Most of articles revealed that endoclip and endoloop were effective tools in prevention of post-polypectomy bleeding. Conclusion Endoclips and endoloops are useful to prevent bleeding after resection of large pedunculated (with thick stalks) polyps. For large sessile and pedunculated (without thick stalks) polyps (diameter>10 mm), the effect of endoclips to prevent post-polypectomy bleeding still needs further discussion. Key words: Intestinal polyps; Hemorrhage; Endoscopes; Nylons; Titanium