Tu1456 Predictors and Significance of Endoclip Retention After Endoscopic Mucosal Resection (EMR) of Large (>20 mm) Colon Polyp

Abstract

Predictors and Significance of Endoclip Retention After Endoscopic Mucosal Resection (EMR) of Large (>20 mm) Colon Polyp Wei-Chung Chen*, Nirav Thosani, Sachin Batra, Gottumukkala S. Raju Gastroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Houston, TX; The Methodist Hospital, Houston, TX; The UT MD Anderson Cancer Center, Houston, TX Background and Aim: Endoclips are commonly used to prevent bleeding and close the defect after endoscopic mucosal resection (EMR). There is growing concern that clip closure may result in tumor in-growth (“buried glands) and prolonged clip retention may interfere with treatment of residual polyps. Our goal is to report prolonged endoclip after EMR, to identify factors predictive of clip retention, and to assess whether clip retention results in tumor ingrowth and recurrence. Method: We performed a retrospective review of prospectively maintained database of all colonic EMR performed by GSR at the UT MD Anderson Cancer Center (6/2009 6/2102). Database contained information regarding patient demographic, referral pattern, polyp characteristics, EMR technique, complications, pathology report and follow up colonoscopy details. All continuous variables were described as medians and IQR and compared using Wilcoxon rank sum test. All categorical variables were listed as frequency and percentages and compared using fisher’s exact test. Results: Of 73 consecutive patients (93 polyps) with polyp size greater than 20 mm, 7 patients (14 polyps) were referred for surgical resection without EMR. Endoscopic Mucosal Resection, was undertaken in 78 polyps in 66 patients (33 men and 33 women). Majority of EMRs were undertaken in the right colon (n 56; 72%) for flat lesions (Paris classification 0-IIa: n 65; 84%) Patient demographic, polyp characteristics and EMR details are shown in (Table 1). Clip Closure of EMR Defect was undertaken in 74 of 78 EMRs. The median number of clips per EMR was 6 (IQR of 4 to 8). Delayed bleeding was noted in 3 cases (3.85%) after resection, which required hospitalization and transfusions; and one patient required endoscopic clip application. Colonoscopy Follow up was performed in 66 EMR cases between 3 to 6 months. Clip Retention was observed in 6 of 63 EMR cases (total 9 retained clips; 1 clip in 3 cases and 2 clips in 3 cases) at follow up colonoscopy. The total clip retention rate was 9.52%. Among patients with retained clips, none of them had recurrence of neoplasia based on histopathology from biopsies obtained at scar site. Predictors of Clip Retention: None of the patient demographic, polyp characteristics and EMR details predicted clip retention. (Table 2). Conclusion: Overall endoclip retention rate at 6 months is low (9.52%) and is not associated with recurrence of neoplasia. None of the clinical and endoscopic factors predict clip retention.