Prevention of delayed post-polypectomy bleeding: Should we amend the 2017 ESGE Guideline?

10.1055/a-1164-6315Colonoscopy and polypectomy of adenomatous polyps decreases risk of colorectal cancer [1] [2]. Bleeding is a known serious complication, with delayed post-polypectomy bleeding (DPPB) occurring at a rate of around 0.23 % to 1.9 % for polyps overall [3] [4] [5], and 7 % for large polyps removed by endoscopic mucosal resection (EMR) [6].

Publikationsverlauf

Artikel online veröffentlicht:
31. August 2020

• References

• 1 Winawer S, Zauber A, Ho M. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
• 2 Nishihara R, Wu K, Lockhead P. et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369: 1095-1105
• 3 Rosen L, Bub D, Reed J. et al. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum 1993; 36: 1126-1131
• 4 Reumkens A, Rondagh EJ, Bakker CM. et al. Post-colonoscopy complications: a systematic review, time trends, and meta-analysis of population-based studies. Am J Gastroenterol 2016; 111: 1092-1101
• 5 Waye J, Lewis B, Yessayan S. Colonoscopy: a prospective report of complications. J Clin Gastroenterol 1992; 15: 347-351
• 6 Metz A, Bourke M, Moss A. et al. Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions. Endoscopy 2011; 43: 506-511
• 7 Kwon MJ, Kim YS, Bae SI. et al. Risk factors for delayed post-polypectomy bleeding. Intest Res 2015; 13: 160-165
• 8 Watanabe K, Nagata N, Yanagisawa N. et al. Effect of antiplatelet agent number, types, and pre-endoscopic management on post-polypectomy bleeding: validation of endoscopy guidelines. Surg Endosc 2020;
• 9 Sawhney M, Salfiti N, Nelson D. et al. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy 2008; 40: 115-119
• 10 Albéniz E, Fraile M, Ibanez B. et al. A Scoring system to determine risk of delayed bleeding after endoscopic mucosal resection of large colorectal lesions. Clin Gastroenterol Hepatol 2016; 14: 1140-1147
• 11 Bahin F, Rasouli K, Byth K. et al. Prediction of clinically significant bleeding following wide-field endoscopic resection of large sessile and laterally spreading colorectal lesions: a clinical risk score. Am J Gastroenterol 2016; 111: 1115-1122
• 12 Liaquat H, Rohn E, Rex DK. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77: 401-407
• 13 Forbes N, Hilsden RJ, Lethebe BC. et al. Prophylactic Endoscopic clipping does not prevent delayed postpolypectomy bleeding in routine clinical practice: a propensity score-matched cohort study. Am J Gastroenterol 2020;
• 14 Feagins LA, Nguyen AD, Iqbal R. et al. The prophylactic placement of hemoclips to prevent delayed post-polypectomy bleeding: an unnecessary practice? A case control study. Dig Dis Sci 2014; 59: 823-828
• 15 Fukata M, Kijima H, Sanjo A. et al. Prophylactic clipping may not eliminate delayed hemorrhage in colonoscopic polypectomies. Jikeikai Med J 2002; 49: 133-142
• 16 Albéniz E, Alvarez MA, Espinos JC. et al. Clip closure after resection of large colorectal lesions with substantial risk of bleeding. Gastroenterology 2019; 157: 1213-21 e4
• 17 Pohl H, Grimm IS, Moyer MT. et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 2019; 157: 977-984 e3
• 18 Zhang QS, Han B, Xu JH. et al. Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest Endosc 2015; 82: 904-909
• 19 Feagins LA, Smith AD, Kim D. et al. Efficacy of prophylactic hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps. Gastroenterology 2019; 157: 967-976 e1
• 20 Dokoshi T, Fujiya M, Tanaka K. et al. A randomized study on the effectiveness of prophylactic clipping during endoscopic resection of colon polyps for the prevention of delayed bleeding. Biomed Res Int 2015; 2015: 490272
• 21 Matsumoto M, Kato M, Oba K. et al. Multicenter randomized controlled study to assess the effect of prophylactic clipping on post-polypectomy delayed bleeding. Dig Endosc 2016; 28: 570-576
• 22 Shioji K, Suzuki Y, Kobayashi M. et al. Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 2003; 57: 691-694
• 23 Quintanilla E, Castro JL, Rabago LR. et al. Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study. J Interv Gastroenterol 2012; 2: 183-188
• 24 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
• 25 Paspatis G, Paraskeva K, Theodoropoulou A. et al. A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. Am J Gastroenterol 2006; 101: 2850; quiz 2913
• 26 Kouklakis G, Mpoumponaris A, Gatopoulou A. et al. Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study. Surg Endosc 2009; 23: 2732-2737
• 27 Kamal FK, Khan S, Marella H. et al. Prophylactic hemoclips in prevention of delayed post-polypectomy bleeding for ≥ 1 cm colorectal polyps: Meta-analysis of randomized controlled trials. Endosc Int Open 2020; 08: E1102-E1110
• 28 Jacobs C, Draganov PV, Yang D. To clip or not to clip: still no closure for all. Transl Gastroenterol Hepatol 2019; 4: 80
• 29 Mori H, Kobara H, Nishiyama N. et al. Simple and reliable treatment for post-EMR artificial ulcer floor with snare cauterization for 10- to 20-mm colorectal polyps: a randomized prospective study (with video). Surg Endosc 2015; 29: 2818-2824
• 30 Ayoub F, Westerveld DR, Forde JJ. et al. Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis. World J Gastroenterol 2019; 25: 2251-2263
• 31 Mangira D, Ket SN, Majeed A. et al. Postpolypectomy prophylactic clip closure for the prevention of delayed postpolypectomy bleeding: A systematic review. JGH Open 2018; 2: 105-110
• 32 Forbes N, Frehlich L, James MT. et al. Routine prophylactic endoscopic clipping is not efficacious in the prevention of delayed post-polypectomy bleeding: a systematic review and meta-analysis of randomized controlled trials. J Can Assoc Gastroenterol 2019; 2: 105-117
• 33 Boumitri C, Mir FA, Ashraf I. et al. Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review. Ann Gastroenterol 2016; 29: 502-508
• 34 Spadaccini M, Albeniz E, Pohl H. et al. Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: meta-analysis of randomized trials. Gastroenterology 2020;
• 35 Ji J-S, Lee K-M, Lee S-W. et al. Effect of prophylactic clip application for the prevention of postpolypectomy bleeding in large pedunculated colonic polyps: a randomized, controlled multicenter trial. United Europ Gastroenterol J 2017; 5: A137
• 36 Osada T, Sakamoto N, Ritsuno H. et al. Closure with clips to accelerate healing of mucosal defects caused by colorectal endoscopic submucosal dissection. Surg Endosc 2016; 30: 4438-4444
• 37 Pellisé M, Desomer L, Burgess N. et al. The influence of clips on scars after EMR: clip artifact. Gastrointest Endosc 2016; 83: 608-616
• 38 Mangira D, Cameron K, Simons K. et al. Cold snare piecemeal EMR of large sessile colonic polyps ≥ 20 mm (with video). Gastrointest Endosc 2020; 910: 1343-1352
• 39 Tutticci N, Hewett D. Cold EMR of large sessile serrated polyps at colonoscopy (with video). Gastrointest Endosc 2018; 87: 837-842