Prevention of Bleeding After Endoscopic Resection of Colonic Polyps: to Clip or not to Clip

Background: Delayed bleeding is a recognised complicationf ollowing colonic endoscopic resection. Prophylactic clip application is often used to reduce this. However, there is a lack of guidelines to support this. Aims: This article aims to review the most recent evidence on the question: 'In patients undergoing endoscopic resection of colonic polyps, does prophylactic clipping of the resection, compared with not clipping, reduce the incidence of delayed bleeding?'. Methods: A rapid assessment was undertaken regarding prophylactic clipping efficacy to reduce delayed bleeding. A search of three databases (Medline, the University of Derby Library Plus and the Cochrane Library) was undertaken to identify articles from the past 4 years. Findings: Eight publications were reviewed: three meta-analyses and five randomised control trials. Five publications recommended against prophylactic clipping following colonic endoscopic resection and three, the most recent publications, strongly recommended it, specifically for those at high risk of delayed bleeding. Conclusion: Prophylactic clip application to reduce delayed bleeding is not effective across all colonic resections. However, there is evidence in favour of clipping for patients with high risk of delayed bleeding.

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Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x565978 ◽

2011 ◽

Vol 93 (3) ◽

pp. 241-245 ◽

Cited By ~ 24

Author(s):

JJ Wood ◽

AC Lord ◽

JMD Wheeler ◽

NR Borley

Keyword(s):

Hospital Stay ◽

Endoscopic Resection ◽

Colonic Polyps ◽

Right Hemicolectomy ◽

Colorectal Polyps ◽

Colonic Resection ◽

Safe Procedure ◽

Median Hospital Stay ◽

Laparoscopic Right Hemicolectomy ◽

Laparoscopic Colon

INTRODUCTION Polypectomy at colonoscopy may be difficult or dangerous. In such instances colonic resection may be indicated. Novel combined laparoscopic-endoscopic procedures have the potential to allow safe extensive extramucosal resection, thus avoiding resection. Laparoscopic colon mobilisation provides a more favourable orientation for endoscopic mucosal resection and facilitates identification of possible perforation sites with immediate laparoscopic repair or resection if necessary. This study aimed to assess the efficacy and safety of laparo-endoscopic resection (LER) of colonic polyps. PATIENTS AND METHODS Data were collected prospectively on consecutive patients undergoing LER. The mode of presentation, referral pattern, lesion site and size, hospital stay, procedural details, complications, histology and further treatment were recorded. RESULTS A total of 13 patients underwent attempted LER (16 polyps in total) and this was completed for 10, with a median hospital stay of 2 days. Five polyps were removed whole and eight piecemeal. Excision was clinically complete in all cases. Three procedures were converted to colonic resection. One lesion appeared malignant, indicating a conversion to laparoscopic right hemicolectomy. Two polyps were not amenable to LER and resection was performed. One patient underwent subsequent colonic resection based on the histological findings. There were no perforations or serious complications. CONCLUSIONS LER is a safe and effective treatment for large and inaccessible colonic polyps that would otherwise be treated by colonic resection.

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Outcome of endoscopic resection of colonic polyps larger than 10 mm in patients with inflammatory bowel disease

Endoscopy International Open ◽

10.1055/a-0953-2021 ◽

2019 ◽

Vol 07 (08) ◽

pp. E994-E1001 ◽

Cited By ~ 4

Author(s):

Siddhant Yadav ◽

Edward V. Loftus ◽

W. Scott Harmsen ◽

Louis M. Wong Kee Song ◽

Nayantara Coelho-Prabhu

Keyword(s):

Inflammatory Bowel Disease ◽

Endoscopic Resection ◽

Bowel Disease ◽

Colonic Polyps ◽

Published Data ◽

Low Grade ◽

Tubular Adenoma ◽

En Bloc ◽

Maximal Diameter ◽

Inflammatory Bowel

Abstract Background and study aims There are limited published data on endoscopic removal of colorectal polyps by endoscopic mucosal resection (EMR) and endoscopic mucosal dissection (ESD) in patients with inflammatory bowel disease (IBD). Patients and methods We performed a retrospective review of patients with colonic IBD and colonic polyps >10mm who underwent EMR and/or ESD at our institution between January 1, 2012 and June 31, 2016. Results Ninety-seven patients with pathology-confirmed IBD (median disease duration 16 years) were included. Mild or moderate active colitis (in background biopsies) was seen in 85 %. Of the total 124 polyps, location was ascending colon in 44 %, transverse in 15 % and sigmoid in 18.5 %; of the total, 55 % were < 20 mm and 45 % were ≥20mm in maximal diameter. Using the Paris classification, 56 % of polyps were polypoid sessile (Is) polyps, while 38 % were non-polypoid (IIa, IIb, IIc). EMR was used in 118 polyps, three required ESD, and three by combined EMR-ESD. Seventy-two percent were resected en-bloc; 28 % underwent piecemeal resection. Histology included low-grade dysplasia in 75, serrated adenoma in 31, and tubular adenoma in 14 polyps. Chromoendoscopy was used in 33 (26.6 %). Adverse events occurred in three patients. Colectomy was performed in 11 patients within 12 months. Recurrence was seen in 20 polyps, 11 of which were successfully resected en-bloc using EMR. Polyps ≥ 20 mm and polyps treated with APC were found to have a statistically significantly higher risk of recurrence. Conclusion This study demonstrates the efficacy and safety of endoscopic resection of large polyps in patients with IBD, making them effective alternatives to colectomy.

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