Endoscopy 2021; 53(S 01): S85
DOI: 10.1055/s-0041-1724469
Abstracts | ESGE Days
ESGE Days 2021 Oral presentations
Saturday, 27 March 2021 14:00 – 14:45 How to minimise bleeding after EMR/ESD Room 6

Effect Of Clip Closure On Outcomes After Resection Of Large Serrated Polyps: Results From A Randomized Trial

SD Crockett
1   University of North Carolina School of Medicine, Division of Gastroenterology and Hepatology, Chapel Hill, United States
,
M Khashab
2   Johns Hopkins Hospital, Division of Gastroenterology and Hepatology, Baltimore, United States
,
DK Rex
3   Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, United States
,
IS Grimm
1   University of North Carolina School of Medicine, Division of Gastroenterology and Hepatology, Chapel Hill, United States
,
JM Levenick
4   Penn State Hershey Medical Center, Division of Gastroenterology and Hepatology, Hershey, United States
,
MT Moyer
4   Penn State Hershey Medical Center, Division of Gastroenterology and Hepatology, Hershey, United States
,
H Pohl
5   Dartmouth Geisel School of Medicine, Hanover, United States
,
Large Polyp Study Consortium › Institutsangaben
 

Aims Sessile serrated lesions (SSL) are most commonly located in the proximal colon, where post-polypectomy bleeding rates are higher. There is limited clinical trial evidence to guide best practices for resection of large serrated polyps (LSP), and whether clip closure of the resection defect is beneficial.

Methods In a multicenter international trial, patients with large (≥20mm) non-pedunculated polyps were randomized to either clipping of the polypectomy defect or not. This analysis is limited to participants with study polyps that had serrated histology [SSL, hyperplastic polyps (HP), or traditional serrated adenomas (TSA)], comparing those randomized to clip vs. control group. The primary outcome was severe post-procedure bleeding within 30 days of colonoscopy. Secondary outcomes included risk of other serious adverse events.

Results 195 participants with 220 serrated study polyps were included in the study. Polyps included 198 SSLs, 14 TSAs, and 8 HPs. The mean age was 63 (SD 9.9), and 53.3 % were female. 39 (20 %) participants used antithrombotic medications, including a higher proportion in the control vs clip group (26 % vs 14 %, p=0.038). Median size of LSPs was 25mm (IQR 20, 30), and 85 % were located in the proximal colon. 99 patients were assigned to clip closure and 96 were assigned to control. Overall, 7 patients (3.6 %) experienced post-procedure bleeding. There was no difference in post-procedure bleeding rates between patients in the clip vs control group (4.2 % vs 3.0 % respectively, p=0.48). 1 patient each had a perforation and post-polypectomy syndrome, both in the control group.

Tab. 1

Total

(n = 195)

Clip group

(n = 99)

Control group

(n = 96)

P value

Severe adverse events, n (%)

10 (5.1)

4 (4.0)

6 (6.2)

0.484

Post-procedure bleeding, n (%)

Proximal/distal, n (%)

7 (3.6)

5 (2.6)/2 (1.0)

3 (4.2)

1 (1.0)/2 (2.0)

4 (3.0)

4 (4.0)/0

0.483

Perforation, n (%)

1 (0.5)

0

1 (1.0)

Post-polypectomy syndrome/abdominal pain, n (%)

2 (0.5)

1 (1.0)

1 (1.0)

Conclusions Results from this clinical trial demonstrate that the post-polypectomy bleeding rate for ≥20mm serrated polyps removed via EMR is low, and that there was not a clear benefit of prophylactic clipping of the polypectomy defect in this group. This study suggests that endoscopic clipping may not be necessary to prevent post-polypectomy bleeding after resection of LSPs.

Citation: Crockett SD, Khashab M, Rex DK et al. OP205 EFFECT OF CLIP CLOSURE ON OUTCOMES AFTER RESECTION OF LARGE SERRATED POLYPS: RESULTS FROM A RANDOMIZED TRIAL. Endoscopy 2021; 53: S85.



Publikationsverlauf

Artikel online veröffentlicht:
19. März 2021

© 2021. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany