Endoscopy 2019; 51(04): S191
DOI: 10.1055/s-0039-1681735
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: Colon: resection 6 ePoster Podium 2
Georg Thieme Verlag KG Stuttgart · New York

FACTORS ASSOCIATED WITH DIFFICULTY IN PROPHYLACTIC CLIP CLOSURE AFTER ENDOSCOPIC MUCOSAL RESECTION OF LARGE COLORECTAL POLYPS

O Ortiz
1   Hospital Clinic de Barcelona, Barcelona, Spain
,
M Pellise
2   Gastroenterology, Hospital Clinic de Barcelona, Barcelona, Spain
,
DK Rex
3   Indiana University School of Medicine, Indianapolis, United States
,
IS Grimm
4   Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, United States
,
MT Moyer
5   Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, United States
,
MK Hasan
6   Center for Interventional Endoscopy, Florida Hospital, Orlando, United States
,
D Pleskow
7   Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, United States
,
BJ Elmunzer
8   Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, United States
,
MA Kashab
9   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
,
O Sanaei
9   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
,
FH Al-Kawas
10   Division of Gastroenterology and Hepatology, Johns Hopkins University, Washington DC, United States
,
S Gordon
11   Department of Gastroenterology and Hepatology, Dartmouth Geisel School of Medicine, Lebanon, United States
,
A Mathew
5   Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, United States
,
JM Levenick
5   Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, United States
,
HR Aslanian
12   Section of Digestive Diseases, Yale-New Haven Hospital, New Haven, United States
,
F Antaki
13   Division of Gastroenterology, John D. Dingell Veterans Affairs Medical Center and Wayne State University, Detroit, United States
,
D Von Renteln
14   Division of Gastroenterology, University of Montreal Medical Center (CHUM) and Research Center (CRCHUM), Montreal, Canada
,
SD Crockett
4   Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, United States
,
A Rastogi
15   Division of Gastroenterology, Hepatology and Motility, University of North Carolina School of Medicine, Chapel Hill, United States
,
JA Gill
16   Division of Gastroenterology James A. Haley VA, University of South Florida, Tampa, United States
,
RJ Law
17   Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, United States
,
P Elias
8   Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, United States
,
TA Mackenzie
18   Department for Biomedical Data Science, The Dartmouth Institute, Lebanon, United States
,
H Pohl
19   Section of Gastroenterology and Hepatology, Dartmouth Geisel School of Medicine, White River Junction, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Evaluate factors associated with inability to achieve prophylactic complete clip closure of the mucosal defect after endoscopic mucosal resection (EMR) of large ≥20 mm non-pedunculated colorectal polyps.

Methods:

This is a post-hoc analysis of a multicenter, randomized trial (CLIP study – NCT01936948) and included all patients that were randomized to the clip arm. Main outcome was complete versus incomplete closure (partial or no closure). The defect was considered completely closed when there was no remaining visible mucosal defect and clips were less than 1 cm apart. Factors associated with clip closure were evaluated in multivariate analysis.

Results:

458 patients (age 65, 58% men) with 494 large polyps were included. Complete clip closure of the resection defect was possible for 338 polyps (68.4%) and was not achieved for 156 (31.6%) polyps; 90 (18.2%) had partial and 66 (13.4%) no closure. Inability to completely close the resection defect was associated with polyp size, adenomatous vs. serrated histology, difficulties of establishing polyp access, incomplete submucosal lifting, and piecemeal resection (Table). Other factors evaluated such as patient characteristics, polyp location, polyp morphology according to Paris, type of submucosal injectate, cautery setting, or ablation of the resection margin were not associated with clip closure.

Tab. 1:

150

Complete closure

N = 338 polyps

N = 313 patients

No complete closure.

N = 156 polyps

N = 145 patients

Adjusted OR

(95% CI)

p

(adjusted)

Characteristics

Size.

*Median (IQR)

*Mean (SD)

Histology

*Serrated, n (%)

*Adenomatous, n (%)

25 (20,31)

28.5 (12.9)

92 (86.8)

246 (63.4)

35 (25.5).

38.4 (16.6)

14 (13.2)

142 (36.6)

0.95 (0.93 – 0.97)

(per mm increase)

1.00

0.37 (0.19 – 0.73)

< 0.001

0.04

Access difficulty

*Easy or moderate n (%)

*Severe, n (%)

323 (70.7)

15 (40.5)

134 (29.3)

22 (59.5)

1.00

0.26 (0.11 – 0.58)

0.001

Mucosal-Lifting

*Complete, n (%)

*Incomplete, n (%)

290 (73.8)

45 (46.4)

103 (26.2)

52 (53.6)

1.00

0.45 (0.26 – 0.78)

0.05

Piecemeal resection

*No, n (%)

*Yes, n (%)

46 (95.8)

292 (65.5)

2 (4.2)

154 (34.5)

1.00

0.13 (0.03 – 0.61)

0.010

Conclusions:

In this multicenter study incomplete closure of the mucosal defect after EMR of large colorectal polyps was associated with polyp and procedure characteristics that reflect more difficult resections. Expertise in clipping of such lesions and investigation in improving clipping technique is needed to maximize clip closure and minimize bleeding risk of EMR.