The Prophylactic Placement of Hemoclips to Prevent Delayed Post-polypectomy Bleeding: An Unnecessary Practice? A Case Control Study

Feagins, Linda A.; Nguyen, Anh D.; Iqbal, Ramiz; Spechler, Stuart J.

doi:10.1007/s10620-014-3055-0

Cited by 47 publications

(46 citation statements)

References 13 publications

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“…[99][100][101] One RCT of post-EMR defect closure by endoclips compared to no intervention failed to demonstrate any significant benefit. 101 The study was however under-powered for this outcome.…”

Section: Endoscopic Mucosal Resectionmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Vanbiervliet²,

et al. 2017

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Section: Endoscopic Mucosal Resectionmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Vanbiervliet²,

et al. 2017

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“…The hemoclip placement can be requested immediately after polyp resection [21,22] ; in one of our cases hemoclip was used to avoid a post polypectomy complication due to a large tearing of small bowel mucosa. No bleeding and surgical complications have been reported after SBE procedure in our patients.…”

mentioning

confidence: 99%

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

Torroni

Romeo

Rea

et al. 2014

WJGE

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AIM:To assess the usefulness of the balloon assisted enteroscopy in preventing surgical intervention in patients with Peutz-Jeghers syndrome (PJS) having a small bowel large polyps. METHODS:Seven consecutive asymptomatic pts (age 15-38 years) with PJS have been collected; six underwent polypectomy using single balloon enteroscopy (Olympus SIF Q180) with antegrade approach using push and pull technique. SBE system consists of the SIF-Q180 enteroscope, an overtube balloon control unit (OBCU Olympus Balloon Control Unit) and a disposable silicone splinting tube with balloon (ST-SB1). All procedures were performed under general anesthesia. Previously all pts received wireless capsule endoscopy (WCE). Prophylactic polypectomy was reserved mainly in pts who had polyps > 15 mm in diameter. The balloon is inflated and deflated by a balloon control unit with a safety pressure setting range from -6.0 kPa to +5.4 kPa. Informed consent has been obtained from pts or parents for each procedure. RESULTS:Six pts underwent polypectomy of small bowel polyps; in 5 pts a large polyp > 15 mm (range 20-50 mm in diameter) was resected; in 1 patient with WCE negative, SBE was performed for previous surgical resection of gastrointestinal stromal tumors. In 2 pts endoscopic clips were placed due to a polypectomy. No surgical complication have been reported. SBE with resection of small bowel large polyps in PJS pts was useful to avoid gastrointestinal bleeding and emergency laparotomy due to intestinal intussusceptions. No gastrointestinal tumors were found in subsequent enteroscopic surveillance in all seven pts. In order surveillance, all pts received WCE, upper endoscopy, ileocolonoscopy every 2 years. No pts had extraintestinal malignant lesions. SBE was performed when WCE was positive for significant polyps (> 15 mm). CONCLUSION:The effective of prophylactic polypectomy of small bowel large polyps (> 15 mm) could be the first line treatment for conservative approach in management of PJS patients. small bowel large polyps is useful to avoid emergency laparotomy after performing wireless capsule endoscopy. The effective of prophylactic polypectomy of small bowel large polyps could be the first line treatment for conservative approach in management of PJS patients.

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“…Despite two papers demonstrating a significant benefit in reducing DPPB after prophylactic clipping, there was no significant difference in DPPB when an overall random effect model was applied (odd ratio: 0.8; 95% CI: 0.36–1.77; P = 0.56). Six studies reported 3121 polyps <20 mm and 766 polyps ≥20 mm . However, prophylactic clippings based on polyp size did not result in any overall significant benefit in DPPB reduction (for polyps <20 mm: odd ratio: 1.16; 95% CI: 0.7–1.92; P = 0.56 and for polyps >20 mm: odd ratio: 0.73; 95% CI: 0.08–7.04; P = 0.79) (Fig.…”

Section: Resultsmentioning

confidence: 95%

“…Seventy‐two full‐text articles were further assessed. Of these, six were considered eligible for inclusion . The earliest study included was published in 2002.…”

Section: Resultsmentioning

confidence: 99%

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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The Prophylactic Placement of Hemoclips to Prevent Delayed Post-polypectomy Bleeding: An Unnecessary Practice? A Case Control Study

Cited by 47 publications

References 13 publications

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Conservative approach in Peutz-Jeghers syndrome: Single-balloon enteroscopy and small bowel polypectomy

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

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