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

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.

Publication History

Article published online:
19 March 2021