Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions

Background: Endoscopic resection of large colorectal lesions is associated with high complication rates. Objective: To evaluate the effect of prophylactic clip closure of polypectomy sites after resection of large (>= 2 cm) sessile and flat colorectal lesions. Design: Retrospective study. Setting: Tertiary referral center. Patients and Interventions: Patients with lesions 2 cm or larger who underwent EMR performed by using low-power coagulation current between January 2000 and February 2012. Beginning in June 2006, polypectomy sites were prophylactically closed with clips when possible. Patients had telephone follow-up at 30 days or later to track complications. Main Outcome Measurements: Delayed hemorrhage, postpolypectomy syndrome, and perforation. Results: There were 524 lesions 2 cm or larger in 463 patients, of which 247 (47.1%) were not clipped, 52 (9.9%) were partially clipped, and 225 (42.9%) were fully clipped. There were 31 delayed hemorrhages, 2 perforations, and 6 cases of postpolypectomy syndrome. The delayed hemorrhage rate was 9.7% in the not clipped group versus 1.8% in the fully clipped group. Multivariate analysis showed that not clipping (odds ratio [OR] 6.0; 95% CI, 2.0-18.5), location proximal to the splenic flexure (OR 2.9; 95% CI, 1.05-8.1), and polyp size (OR 1.3; 95% CI, 1.1-1.7 for each 10-mm increase in size) were associated with delayed bleeding. Limitation: Retrospective design. Conclusions: Prophylactic clipping of resection sites after endoscopic removal of large (>= 2 cm) colorectal lesions using low-power coagulation current reduced the risk of delayed postpolypectomy hemorrhage. A randomized, prospective trial of clipping large polypectomy sites is warranted. (Gastrointest Endosc 2013;77:401-7.)