Practice patterns and predictors of prophylactic endoscopic clip usage during polypectomy

Abstract Background and study aims Prophylactic endoscopic clips are commonly placed during polypectomy to reduce risk of delayed bleeding, although evidence to support this practice is unclear. Our study aimed to: (1) identify variables associated with prophylactic clip use; (2) explore variability between endoscopists’ clipping practices and (3) study temporal trends in prophylactic clip use. Patients and methods This was a retrospective cohort study in a high-volume unit dedicated to screening-related colonoscopies. Colonoscopies involving polypectomy from 2008 to 2014 were reviewed. The primary outcome was prophylactic clipping status, both at the patient level and per polyp. Hierarchical regression models yielded adjusted odds ratios (AORs) to determine predictors of prophylactic clipping. Results A total of 8,366 colonoscopies involving 19,129 polypectomies were included. Polyp size ≥ 20 mm was associated with higher clip usage (AOR 2.94; 95 % CI: 2.43, 3.54) compared to polyps < 10 mm. Right-sided polyps were more likely to be clipped (AOR 2.78; 95 % CI: 2.34, 3.30) relative to the rectum. Surgeons clipped less than gastroenterologists (OR 0.52; 95 % CI: 0.44, 0.63). From 2008 to 2014, the crude proportion of prophylactically clipped cases increased by 7.4 % (95 % CI: 7.1, 7.6) from 1.9 % to 9.3 %. Significant inter-endoscopist variability in clipping practices was observed, notably, for polyps < 10 mm. Conclusions Prophylactic clip usage was correlated with established risk factors for delayed bleeding. Significantly increased clip usage over time was shown. Given that evidence does not clearly support prophylactic clipping, there is a need to educate practitioners and limit healthcare resource utilization.

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A Simulated Randomized Control Trial of Endoscopic Clip Placement to Prevent Delayed Bleeding after Colonic Polypectomy On and Off Anticoagulation

The American Journal of Gastroenterology ◽

10.14309/00000434-201110002-01381 ◽

2011 ◽

Vol 106 ◽

pp. S529

Author(s):

Neehar Parikh ◽

Robert Young ◽

Andrew Gawron

Keyword(s):

Randomized Control Trial ◽

Endoscopic Clip ◽

Delayed Bleeding ◽

Randomized Control

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Risk factors for post-polypectomy bleeding; a retrospective case-control study of a high-volume colonoscopy center

Zeitschrift für Gastroenterologie ◽

10.1055/a-1690-7795 ◽

2021 ◽

Author(s):

Dimitrios Eleftheriadis ◽

Christina Imalis ◽

Guido Gerken ◽

Heiner Wedemeyer ◽

Jan Duerig

Keyword(s):

Risk Factors ◽

Significant Risk ◽

Ileocecal Valve ◽

Binary Logistic Regression ◽

High Volume ◽

Binary Logistic Regression Analysis ◽

Care Hospital ◽

Retrospective Case ◽

Polyp Size ◽

Epinephrine Injection

Abstract Background and aim Post-polypectomy bleeding (PPB) remains an uncommon although serious complication of colonoscopy. The aim of this study is to determine the PPB-prevalence in a secondary care hospital and its associated risk factors. Patients and methods We collected data from 581 patients, with the removal of 1593 polyps between August 2017 and August 2019. A univariate binary logistic regression analysis was conducted retrospectively. Results PPB occurred in only 10 cases, representing 1.7% of patients: immediate in 1.2% and delayed in 0.5%. The number of removed polyps per patient [4.5 (SD 2.59) for hemorrhagic vs. 2.74 (SD 1.98) for non-hemorrhagic group] and the propofol dose [232 mg (SD 93.07) for hemorrhagic vs. 133 mg (SD 57.28) for non-hemorrhagic group] were relevant patient-related risk factors. The polyp-based analysis showed the polyp size [18.4 mm (SD 10.44) for hemorrhagic vs. 4.42 mm (SD 4.29) for non-hemorrhagic group], the morphology [wide-based: OR 24.83 (95 % CI 2.76 – 223.44), pedunculated: OR 56.67 (95 % CI 5.03 – 638.29)], the location at ileocecal valve [OR 20.48, 95 % CI 1.81 – 231.97)], and the polypectomy method [hot snare piecemeal with epinephrine injection: OR 75.38 (95 % CI 7.67 – 741.21)] as significant risk factors for PPB, too. Conclusions The low rate of PPB confirms the safety of the procedure in non-tertiary, high-volume colonoscopy centers. The number of polyps removed per patient, the polyp size, morphology and location, as well as the sedation dose and the method of polypectomy were shown as relevant risk factors.

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Safety Issues in Magnetic Resonance Imaging Scan with Retention of Olympus Long Clips in the Gastrointestinal Tract

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210624125335 ◽

2021 ◽

Vol 17 ◽

Author(s):

Cheng-Yi Wang ◽

Wei-Chou Chang ◽

Hsin-Hung Huang ◽

Wei-Kuo Chang ◽

Yu-Lueng Shih ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Magnetic Resonance Imaging Scan ◽

Resonance Imaging ◽

Endoscopic Clip ◽

Serious Adverse Event ◽

Safety Issues ◽

Endoscopic Clips ◽

Mri Scans ◽

Magnetic Resonance Imaging Mri

Objective: Not all endoscopic clips are compatible with magnetic resonance imaging (MRI). The aim of this study is to investigate the safety of MRI-incompatible endoscopic clips in patients undergoing MRI scans. Methods: We retrospectively reviewed the medical records of patients who had received endoscopic clip placement of Olympus Long Clip MRI-incompatible clips and then had undergone MRI scans within two weeks in our hospital between 2014 and 2019. Results: A total of 44,292 patients had undergone an MRI examination at our hospital. Only 15 patients had MRI scans within two weeks after the endoscopic clip placement. Their median age was 65.5 years, and 12 of the 15 patients were men. At the time of the clip placement and MRI scan, four patients were taking anti-coagulation or anti-platelet agents. The indication for endoscopic clip placement of the 15 patients was mucosal/submucosal defect or hemorrhage and colonic perforation. Endoscopic clips were placed in the colon of 14 patients and in the stomach of only one patient for gastric hemorrhage. One patient experienced clip migration and three displayed artifacts in abdominal images. No patient complications of mortality, hemorrhage, or organ perforation occurred. Conclusion: No serious adverse event occurred during MRI scans of patients with MRI-incompatible clips in this study, suggesting that MRI-incompatible clips may be safe to use in MRI scans. However, this does not guarantee the safety of the Long Clip for MRI scans, as further tests are needed to verify that this clip is safe for use during MRI.

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Abstract 4: Variation and Temporal Trends in the Characteristics of US Hospitals Treating Acute Ischemic Stroke Patients with IV-tPA: Findings from GWTG-Stroke

Stroke ◽

10.1161/str.44.suppl_1.a4 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Lee H Schwamm ◽

Syed F Ali ◽

Mathew J Reeves ◽

Eric E Smith ◽

Jeffrey L Saver ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Systems Of Care ◽

Team Building ◽

Temporal Trends ◽

High Volume ◽

Wilcoxon Test ◽

Chi Square ◽

Over Time ◽

Iv Tpa

Introduction: Utilization of IV tPA is challenging for many hospitals. Using data from the national Get With The Guidelines-Stroke program, we analyzed changes over time in the characteristics of the hospitals that treated patients with tPA. Methods: We analyzed patient-level data from 2003-2011 at 1600 GWTG hospitals that joined the program at any time during the study period and admitted any acute ischemic stroke (AIS) patients arriving ≤ 2 hr of onset and eligible for tPA. Descriptive trends by time were analyzed by chi-square or Wilcoxon test for continuous data. Results: IV tPA was given within 3 hr at 1394 sites to 50,798/ 75,115 (67.6%) eligible AIS patients arriving ≤ 2 hr; 206 (14.8%) sites had a least one eligible patients but no tPA use. IV tPA treatment rates varied substantially across hospitals (median 61.2%, range 0-100%), with > 200 hospitals providing tPA < 10% of the time (Figure). Over time, more patients and a larger proportion of patients were treated at smaller (median bed size 407 vs. 372, p< 0.001), non-academic, Southern hospitals, and those with lower annualized average ischemic stroke volumes (252.4 vs. 235.2, p< 0.001) (Table). While more than half of all tPA patients were treated at Primary Stroke Centers, this proportion did not change over time. The proportion of patients treated at high volume tPA treatment sites (average > 20/year) increased over time (31.9 vs. 34.5, p< 0.007). Conclusion: Over the past decade, while primary stroke centers still account for more than half of all treatments, tPA has been increasingly delivered in smaller, non-academic hospitals. These data support the continued emphasis on stroke team building and systems of care at US hospitals.

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Building a model for day case hiatal surgery - Lessons learnt over a 10 year period in a high volume unit: A case series

International Journal of Surgery ◽

10.1016/j.ijsu.2018.04.039 ◽

2018 ◽

Vol 54 ◽

pp. 82-85 ◽

Cited By ~ 1

Author(s):

Pritesh Mistry ◽

Shafquat Zaman ◽

Iestyn Shapey ◽

Markos Daskalakis ◽

Rajwinder Nijjar ◽

...

Keyword(s):

Case Series ◽

High Volume ◽

Day Case ◽

Lessons Learnt ◽

Volume Unit

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Histopathological characteristics of adrenal incidentalomas in a high volume unit, a 7-year experience

International Journal of Surgery ◽

10.1016/j.ijsu.2014.07.152 ◽

2014 ◽

Vol 12 ◽

pp. S37

Author(s):

Michael Feretis ◽

Philippa Orchard ◽

Taw Chin Cheong ◽

Chas Ubhi

Keyword(s):

High Volume ◽

Adrenal Incidentalomas ◽

Volume Unit

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Temporal trends in centralization and racial disparities in utilization of high-volume hospitals for lung cancer surgery

Medicine ◽

10.1097/md.0000000000006573 ◽

2017 ◽

Vol 96 (16) ◽

pp. e6573 ◽

Cited By ~ 7

Author(s):

Wil Lieberman-Cribbin ◽

Bian Liu ◽

Emanuele Leoncini ◽

Raja Flores ◽

Emanuela Taioli

Keyword(s):

Lung Cancer ◽

Racial Disparities ◽

Temporal Trends ◽

Lung Cancer Surgery ◽

High Volume ◽

Cancer Surgery

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High Subarachnoid Hemorrhage Patient Volume Associated With Lower Mortality and Better Outcomes

Neurosurgery ◽

10.1227/neu.0000000000000850 ◽

2015 ◽

Vol 77 (3) ◽

pp. 462-470 ◽

Cited By ~ 37

Author(s):

Aditya S. Pandey ◽

Joseph J. Gemmete ◽

Thomas J. Wilson ◽

Neeraj Chaudhary ◽

B. Gregory Thompson ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Temporal Trends ◽

High Volume ◽

Patient Volume ◽

Inpatient Mortality ◽

Discharge Home ◽

Volume Outcome ◽

Low Volume ◽

Aggressive Care

Abstract BACKGROUND: High-volume centers have better outcomes than low-volume centers when managing complex conditions including subarachnoid hemorrhage (SAH). OBJECTIVE: To quantify SAH volume-outcome association and determine the extent to which this association is influenced by aggressiveness of care. METHODS: A serial cross-sectional retrospective study using the Nationwide Inpatient Sample for 2002 to 2010 was performed. Included were all adult (older than 18 years of age) discharged patients with a primary diagnosis of SAH admitted from the emergency department or transferred to a discharging hospital; cases of trauma or arteriovenous malformation were excluded. Survey-weighted descriptive statistics estimated temporal trends. Multilevel logistic regression estimated volume-outcome associations for inpatient mortality and discharge home. Models were adjusted for demographic characteristics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and all patient-refined, diagnosis-related group mortality. Analyses were repeated, excluding cases in which aggressive care was not pursued. RESULTS: A total of 32 336 discharges were included; 13 398 patients underwent clipping (59.1%) or coiling (40.9%). The inpatient mortality rate decreased from 32.2% in 2002 to 22.2% in 2010; discharge home increased from 28.5% to 40.8% during the same period. As SAH volume decreased from 100/year, the mortality rate increased from 18.7% to 19.8% at 80/year, 21.7% at 60/year, 24.5% at 40/year, and 28.4% at 20/year. As SAH patient volume decreased, the probability of discharge home decreased from 40.3% at 100/year to 38.7% at 60/year, and 35.3% at 20/year. Better outcomes persisted in patients receiving aggressive care and in those not receiving aggressive care. CONCLUSION: Short-term SAH outcomes have improved. High-volume hospitals have more favorable outcomes than low-volume hospitals. This effect is substantial, even for hospitals conventionally classified as high volume.

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