Su1647 Cost-Effectiveness of Prophylactic Clipping After Colorectal Endoscopic Mucosal Resection and Economic Impact According to a Bleeding Risk Score

2016 ◽  
Vol 83 (5) ◽  
pp. AB377-AB378 ◽  
Author(s):  
Eduardo Albeniz ◽  
Maria Fraile Gonzalez ◽  
David Martínez-Ares ◽  
Pedro Alonso ◽  
Carlos Guarner-Argente ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Economic Impact ◽  
Endoscopic Mucosal Resection ◽  
Risk Score ◽  
Bleeding Risk ◽  
Mucosal Resection

332 Delayed Bleeding Risk Score for Colorectal Endoscopic Mucosal Resection

2015 ◽  
Vol 81 (5) ◽  
pp. AB135-AB136 ◽  
Author(s):  
Eduardo Albeniz ◽  
María Fraile ◽  
David MartíNez-Ares ◽  
Noel Pin ◽  
Pedro Alonso ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Risk Score ◽  
Bleeding Risk ◽  
Delayed Bleeding ◽  
Mucosal Resection

scholarly journals Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ayla S. Turan ◽  
◽  
Leon M. G. Moons ◽  
Ramon-Michel Schreuder ◽  
Erik J. Schoon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Endoscopic Mucosal Resection ◽  
Intervention Group ◽  
Proximal Colon ◽  
Control Group ◽  
Colon Polyps ◽  
Delayed Bleeding ◽  
Randomized Controlled ◽  
Mucosal Resection

Abstract Background Endoscopic mucosal resection (EMR) for large colorectal polyps is in most cases the preferred treatment to prevent progression to colorectal carcinoma. The most common complication after EMR is delayed bleeding, occurring in 7% overall and in approximately 10% of polyps ≥ 2 cm in the proximal colon. Previous research has suggested that prophylactic clipping of the mucosal defect after EMR may reduce the incidence of delayed bleeding in polyps with a high bleeding risk. Methods The CLIPPER trial is a multicenter, parallel-group, single blinded, randomized controlled superiority study. A total of 356 patients undergoing EMR for large (≥ 2 cm) non-pedunculated polyps in the proximal colon will be included and randomized to the clip group or the control group. Prophylactic clipping will be performed in the intervention group to close the resection defect after the EMR with a distance of < 1 cm between the clips. Primary outcome is delayed bleeding within 30 days after EMR. Secondary outcomes are recurrent or residual polyps and clip artifacts during surveillance colonoscopy after 6 months, as well as cost-effectiveness of prophylactic clipping and severity of delayed bleeding. Discussion The CLIPPER trial is a pragmatic study performed in the Netherlands and is powered to determine the real-time efficacy and cost-effectiveness of prophylactic clipping after EMR of proximal colon polyps ≥ 2 cm in the Netherlands. This study will also generate new data on the achievability of complete closure and the effects of clip placement on scar surveillance after EMR, in order to further promote the debate on the role of prophylactic clipping in everyday clinical practice. Trial registration ClinicalTrials.gov NCT03309683. Registered on 13 October 2017. Start recruitment: 05 March 2018. Planned completion of recruitment: 31 August 2021.

scholarly journals Clinical impact of the perioperative management of oral anticoagulants in bleeding after colonic endoscopic mucosal resection

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shoko Ono ◽  
Marin Ishikawa ◽  
Kana Matsuda ◽  
Momoko Tsuda ◽  
Keiko Yamamoto ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Perioperative Management ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Multivariate Logistic Regression Analysis ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Clinical Impact ◽  
Antithrombotic Agents ◽  
Mucosal Resection

Abstract Background Heparin bridging therapy (HBT) is indeed related to a high frequency of bleeding after endoscopic mucosal resection (EMR). In this study, our aim was to investigate clinical impact of management of oral anticoagulants without HBT in bleeding after colonic EMR. Methods From data for patients who underwent consecutive colonic EMR, the relationships of patient factors and procedural factors with the risk of bleeding were analysed. Our management of antithrombotic agents was based on the shortest cessation as follows: the administration of warfarin was generally continued within the therapeutic range, and direct oral anticoagulants (DOACs) were not administered on the day of the procedure. We calculated bleeding risks after EMR in patients who used antithrombotic agents and evaluated whether perioperative management of anticoagulants without HBT was beneficial for bleeding. Results A total of 1734 polyps in 825 EMRs were analysed. Bleeding occurred in 4.0% of the patients and 1.9% of the polyps. The odds ratios for bleeding using multivariate logistic regression analysis were 3.67 in patients who used anticoagulants and 4.95 in patients who used both anticoagulants and antiplatelet agents. In patients with one-day skip of DOACs, bleeding occurred in 6.5% of the polyps, and there were no significant differences in bleeding risk between HBT and continuous warfarin or one-day skip DOACs. Conclusions The use of oral anticoagulants was related to bleeding after colonic EMR, and perioperative management of oral anticoagulants based on the shortest cessation without HBT would be clinically acceptable.

The Answer to “When to Clip” After Colorectal Endoscopic Mucosal Resection Based on a Cost-Effectiveness Analysis

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Eduardo Albéniz ◽  
Mónica Enguita-Germán ◽  
Antonio Zebenzuy Gimeno-García ◽  
Alberto Herreros de Tejada ◽  
Oscar Nogales ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Mucosal Resection ◽  
Cost Effectiveness Analysis ◽  
Mucosal Resection ◽  
Effectiveness Analysis

Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis

Gut ◽  
2017 ◽  
Vol 67 (11) ◽  
pp. 1965-1973 ◽  
Author(s):  
Farzan F Bahin ◽  
Steven J Heitman ◽  
Khalid N Rasouli ◽  
Hema Mahajan ◽  
Duncan McLeod ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Submucosal Dissection ◽  
Incremental Cost ◽  
Endoscopic Mucosal Resection ◽  
Cost Effectiveness Analysis ◽  
Wide Field ◽  
Tree Model ◽  
Mucosal Resection ◽  
Submucosal Dissection ◽  
Effectiveness Analysis

ObjectiveTo compare the cost-effectiveness of endoscopic submucosal dissection (ESD) and wide-field endoscopic mucosal resection (WF-EMR) for removing large sessile and laterally spreading colorectal lesions (LSLs) >20 mm.DesignAn incremental cost-effectiveness analysis using a decision tree model was performed over an 18-month time horizon. The following strategies were compared: WF-EMR, universal ESD (U-ESD) and selective ESD (S-ESD) for lesions highly suspicious for containing submucosal invasive cancer (SMIC), with WF-EMR used for the remainder. Data from a large Western cohort and the literature were used to inform the model. Effectiveness was defined as the number of surgeries avoided per 1000 cases. Incremental costs per surgery avoided are presented. Sensitivity and scenario analyses were performed.Results1723 lesions among 1765 patients were analysed. The prevalence of SMIC and low-risk-SMIC was 8.2% and 3.1%, respectively. Endoscopic lesion assessment for SMIC had a sensitivity and specificity of 34.9% and 98.4%, respectively. S-ESD was the least expensive strategy and was also more effective than WF-EMR by preventing 19 additional surgeries per 1000 cases. 43 ESD procedures would be required in an S-ESD strategy. U-ESD would prevent another 13 surgeries compared with S-ESD, at an incremental cost per surgery avoided of US$210 112. U-ESD was only cost-effective among higher risk rectal lesions.ConclusionS-ESD is the preferred treatment strategy. However, only 43 ESDs are required per 1000 LSLs. U-ESD cannot be justified beyond high-risk rectal lesions. WF-EMR remains an effective and safe treatment option for most LSLs.Trial registration numberNCT02000141.

Su1629 Cost Effectiveness of Endoscopic Mucosal Resection Compared to Transanal Resection of Complex Rectal Polyps

2017 ◽  
Vol 85 (5) ◽  
pp. AB371
Author(s):  
Jessica X. Yu ◽  
W.A. Russell ◽  
Nathan G. Kim ◽  
Jack Ching ◽  
Eran Bendavid ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Mucosal Resection ◽  
Transanal Resection ◽  
Mucosal Resection ◽  
Rectal Polyps

scholarly journals Randomised controlled trial of transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND Study)

Gut ◽  
2017 ◽  
Vol 67 (5) ◽  
pp. 837-846 ◽  
Author(s):  
Renée M Barendse ◽  
Gijsbert D Musters ◽  
Eelco J R de Graaf ◽  
Frank J C van den Broek ◽  
Esther C J Consten ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Mucosal Resection ◽  
Transanal Endoscopic Microsurgery ◽  
Controlled Trial ◽  
Cost Effective ◽  
High Rate ◽  
Complication Rates ◽  
Mucosal Resection ◽  
Life Years ◽  
Endoscopic Microsurgery

ObjectiveNon-randomised studies suggest that endoscopic mucosal resection (EMR) is equally effective in removing large rectal adenomas as transanal endoscopic microsurgery (TEM), but EMR might be more cost-effective and safer. This trial compares the clinical outcome and cost-effectiveness of TEM and EMR for large rectal adenomas.DesignPatients with rectal adenomas ≥3 cm, without malignant features, were randomised (1:1) to EMR or TEM, allowing endoscopic removal of residual adenoma at 3 months. Unexpected malignancies were excluded postrandomisation. Primary outcomes were recurrence within 24 months (aiming to demonstrate non-inferiority of EMR, upper limit 10%) and the number of recurrence-free days alive and out of hospital.ResultsTwo hundred and four patients were treated in 18 university and community hospitals. Twenty-seven (13%) had unexpected cancer and were excluded from further analysis. Overall recurrence rates were 15% after EMR and 11% after TEM; statistical non-inferiority was not reached. The numbers of recurrence-free days alive and out of hospital were similar (EMR 609±209, TEM 652±188, p=0.16). Complications occurred in 18% (EMR) versus 26% (TEM) (p=0.23), with major complications occurring in 1% (EMR) versus 8% (TEM) (p=0.064). Quality-adjusted life years were equal in both groups. EMR was approximately €3000 cheaper and therefore more cost-effective.ConclusionUnder the statistical assumptions of this study, non-inferiority of EMR could not be demonstrated. However, EMR may have potential as the primary method of choice due to a tendency of lower complication rates and a better cost-effectiveness ratio. The high rate of unexpected cancers should be dealt with in further studies.

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