Prophylactic clipping for the prevention of bleeding following wide-field endoscopic mucosal resection of laterally spreading colorectal lesions: an economic modeling study

Bahin, Farzan F.; Rasouli, Khalid N.; Lee, Eric Y.T.; Bourke, Michael J.

doi:10.1055/s-0042-105558

Cited by 34 publications

(36 citation statements)

References 24 publications

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“…For example, prophylactic coagulation of visible vessels in the resection defect did not signifi cantly decrease CSPEB in a randomized controlled trial of 347 patients ( 16 ). Th ere may be a role for prophylactic clipping of the resection defect ( 7 ); however, there is limited evidence, questionable cost-eff ectiveness, and practical diffi culty, particularly for large resection defects ( 17,18 ). Th us reliable risk stratifi cation of CSPEB is of great value, especially for patients at greatest risk for such an adverse event.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Bahin

Rasouli

Byth

et al. 2016

American Journal of Gastroenterology

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Section: Discussionmentioning

confidence: 99%

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Bahin

Rasouli

Byth

et al. 2016

American Journal of Gastroenterology

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“…Cost analyses from the study by Bahin et al . were based on a single tertiary referral center in an Australian setting, which limits the universal applicability of the findings . In addition, the authors measured only direct costs resulting from the clinical management of DPPB; nonfinancial costs and indirect costs incurred by the individual or society were not considered …”

Section: Discussionmentioning

confidence: 99%

“…However, this is not currently the case. Bahin et al 26 assessed the cost effectiveness of the prophylactic clip placement strategy by applications of an economic model to the outcomes of an Australian colonic endoscopic mucosal resection study. This model demonstrated that it would cost a minimum of €1500 to prevent one DPPB event with presumed 100% clip efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Cost analyses from the study by Bahin et al were based on a single tertiary referral center in an Australian setting, which limits the universal applicability of the findings. 26 In addition, the authors measured only direct costs resulting from the clinical management of DPPB; nonfinancial costs and indirect costs incurred by the individual or society were not considered. 26,27 In conclusion, this systematic review of RCTs and casecontrol studies has found that prophylactic clip closure after uncomplicated polypectomy did not significantly reduce the risk of DPPB, although there is a trend toward benefit in polyps ≥20 mm.…”

Section: Discussionmentioning

confidence: 99%

“…26 In addition, the authors measured only direct costs resulting from the clinical management of DPPB; nonfinancial costs and indirect costs incurred by the individual or society were not considered. 26,27 In conclusion, this systematic review of RCTs and casecontrol studies has found that prophylactic clip closure after uncomplicated polypectomy did not significantly reduce the risk of DPPB, although there is a trend toward benefit in polyps ≥20 mm. Prophylactic clip application in scenarios where risk of DPPB is increased may be beneficial, although there is little evidence to currently support its routine use.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Postpolypectomy prophylactic clip closure for the prevention of delayed postpolypectomy bleeding: A systematic review

2018

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Delayed postpolypectomy bleeding (DPPB) is the most common complication of colonoscopic polypectomy. Prophylactic clipping after an uncomplicated polypectomy is increasingly used, but it is unclear if this results in the prevention of DPPB. This study aimed to review prophylactic clip use and its effect on the rates of DPPB. MEDLINE, Embase, and the Cochran Library were systematically searched for studies (1995–March 2017) that used prophylactic hemoclips and assessed DPPB as an outcome. Of 1402 articles identified, nine papers were eligible for inclusion, evaluating 4311 patients and 7783 polyps; 118 patients experienced a DPPB, and 49 of these patients received prophylactic clips. There was no significant difference in DPPB rates in patients who received prophylactic clipping compared to those who did not (odd ratio: 0.8; 95% confidence interval: 0.36–1.77; P = 0.56). There was also no significant difference in the DPPB of polyps <20 mm compared with polyps ≥20 mm. Clip application for prophylactic management of an uncomplicated polypectomy has not been demonstrated to reduce the risk of DPPB, casting doubt on the use of this costly practice.

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Novel clip device for prevention of bleeding after endoscopic papillectomy

et al. 2021

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Objectives Recently, a novel clip device, SureClip ® (Micro‐Tech Co. Ltd., Nanjing, China), has been developed, which improved rotation and reopening performance. We aimed to assess the efficacy of the SureClip ® in prophylactic closure of the mucosal break after endoscopic papillectomy (EP) for ampullary neoplasm. Methods We retrospectively reviewed the medical records of 40 patients who underwent EP for ampullary neoplasms between October 2009 and March 2020. Prophylactic closure after resection was performed using the conventional clip between 2014 and 2018, and with the SureClip ® after 2019. The baseline characteristics, techniques, outcomes, and complications of EP were analyzed. Results The median age of the patients (25 males and 15 females) was 70 years. The en block resection rate was 82.5% and the curative resection rate was 80.0%. Histologically, 11 (27.5%) patients had malignancy. Prophylactic closure was performed in 29 (72.5%) patients (17 conventional clips, 12 SureClip ® ). Complications occurred in 18 (45.0%) patients, including postprocedure bleeding in 9 (22.5%) patients. However, no postprocedure bleeding was observed in the patients who received prophylactic closure using the SureClip ® ( p = 0.038). All other factors were not significantly correlated with postprocedure bleeding. The duration of hospital stay after EP was significantly shorter in patients treated with the SureClip ® compared to those treated with a conventional clip or without clips ( p < 0.05). Conclusions In the present study, prophylactic clipping of the mucosal break using the SureClip ® was effective in preventing bleeding after EP.

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Prophylactic clipping for the prevention of bleeding following wide-field endoscopic mucosal resection of laterally spreading colorectal lesions: an economic modeling study

Abstract: ClinicalTrials.gov (NCT01368289).

Cited by 34 publications

References 24 publications

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Postpolypectomy prophylactic clip closure for the prevention of delayed postpolypectomy bleeding: A systematic review

Novel clip device for prevention of bleeding after endoscopic papillectomy

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