The influence of clips on scars after EMR: clip artifact

Pellisé, María; Desomer, Lobke; Burgess, Nicholas G.; Williams, Stephen J.; Sonson, Rebecca; McLeod, Duncan; Bourke, Michael J.

doi:10.1016/j.gie.2015.08.071

Cited by 33 publications

(19 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The drawback of complete closure for prophylactic clipping is an aberrant appearance of the EMR scar due to tissue traction by the clips, the clip artifact. It has been reported in approximately a third of clipped patients, especially after prophylactic clipping [56]. It is characterized by mucosal nodules and granular tissue with notches (see Figure 4b).…”

Section: Tts Clipmentioning

confidence: 93%

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

Turan

Ultee

Geenen

et al. 2019

Expert Review of Medical Devices

View full text Add to dashboard Cite

Introduction: The most commonly used treatment for advanced colorectal adenomas is endoscopic mucosal resection (EMR). The increased number of EMRs since the introduction of the screening program for colorectal cancer has resulted in an increase in EMR-related complications. This review summarizes the current knowledge for the use of clips for the treatment and prevention of complications after EMR. Areas covered: The historical development of clips is summarized and their properties are evaluated. An overview is presented of the evidence for therapeutic and prophylactic clipping for bleeding or perforation after EMR in the colon. Several clipping techniques are discussed in relation to the efficacy of wound closure. Furthermore, new techniques that will likely influence the use of clips in the future endoscopic practice, such as endoscopic full-thickness resection (eFTR) are also highlighted. Expert commentary: Most research focuses on prophylactic clipping for delayed bleeding after EMR of large adenomas. We advocate a distance of 0.5-1.0 cm between aligning clips. This focus may likely shift from bleeding to perforation. Here, endoscopic treatment with through-the-scope clips and largediameter clips may well replace surgery. The future role of clips will also depend on the further development of new endoscopic technologies, such as eFTR.

show abstract

Section: Tts Clipmentioning

confidence: 93%

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

Turan

Ultee

Geenen

et al. 2019

Expert Review of Medical Devices

View full text Add to dashboard Cite

show abstract

“…Previous studies have shown that clip artifact was associated with a higher number of clips used. 10 In the study by Pellisé et al, 11 clips placed as prophylaxis of postprocedural bleeding were more often associated with clip artifact than were those placed for treatment of intraprocedural bleeding or deep muscularis propia injury. The authors speculate that this may occur because closing the whole mucosal defect may result in significant tissue tension as the edges are drawn together, probably requiring more clips.…”

mentioning

confidence: 98%

“…The second study, from the Sydney group, described nodules of elevated normal mucosa in 11 of 62 post-EMR scars and a residual clip surrounded by granulation tissue in 13 additional scars, resulting in an overall "clip artifact" rate of 47%. 11 In 5 cases, recurrence was simultaneously present with clip artifact. The assessment of post-EMR sites was challenging because nodules secondary to granulation tissue coexisted with nodules secondary to neoplastic tissue in the same scar.…”

mentioning

confidence: 99%

“…More importantly, in both cases, despite the use of high-definition endoscopes and narrow-band imaging, optical diagnosis was not accurate, and the residual adenoma was diagnosed only by histologic examination. 11 Mucosal and vascular patterns may be difficult to interpret in the context of inflammation and regeneration; as a result, residual neoplasia may be misdiagnosed. Accordingly, in cases of dubious unspecific mucosal changes without typical adenomatous or normal pit patterns, it is still advisable to take biopsy specimens and further ablate.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Retained clips: A new challenge for post-EMR surveillance?

Pellisé

Rivero-Sánchez

2017

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

“…Clips may also complicate assessment of post-resection scars by creating artefactual mucosal nodules that must be carefully examined to distinguish them from recurrent adenoma. Usually the distinction is clear based on the morphology and surface pattern 17 . It is also possible (but unreported) that clips may “bury” small areas of residual or recurrent adenoma, preventing detection and resection at surveillance colonoscopy and creating a theoretical risk of subsequent delayed adenomatous recurrence or post-colonoscopy cancer.…”

mentioning

confidence: 99%