Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps.

BACKGROUND AND STUDY AIM : Delayed bleeding is a common adverse event following endoscopic mucosal resection (EMR) of large colorectal polyps. Prophylactic clip closure of the mucosal defect after EMR of nonpedunculated polyps larger than 20 mm reduces the incidence of severe delayed bleeding, especially in proximal polyps. This study aimed to evaluate factors associated with complete prophylactic clip closure of the mucosal defect after EMR of large polyps. METHODS : This is a post hoc analysis of the CLIP study (NCT01936948). All patients randomized to the clip group were included. Main outcome was complete clip closure of the mucosal resection defect. The defect was considered completely closed when no remaining mucosal defect was visible and clips were less than 1 cm apart. Factors associated with complete closure were evaluated in multivariable analysis. RESULTS : In total, 458 patients (age 65, 58 % men) with 494 large polyps were included. Complete clip closure of the resection defect was achieved for 338 polyps (68.4 %); closure was not complete for 156 (31.6 %). Factors associated with complete closure in adjusted analysis were smaller polyp size (odds ratio 1.06 for every millimeter decrease [95 % confidence interval 1.02-1.08]), good access (OR 3.58 [1.94-9.59]), complete submucosal lifting (OR 2.28 [1.36-3.90]), en bloc resection (OR 5.75 [1.48-22.39]), and serrated histology (OR 2.74 [1.35-5.56]). CONCLUSIONS : Complete clip closure was not achieved for almost one in three resected large nonpedunculated polyps. While stable access and en bloc resection facilitate clip closure, most factors associated with clip closure are not modifiable. This highlights the need for alternative closure options and measures to prevent bleeding.

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The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government. Heiko Pohl has received research funding from Boston Scientific and US Endoscopy. María Pellisé has received research grant from Fujifilm, consultancy fees from Norgine, speaker’s fees from Norgine, Olympus, Casen Recordati, and Janssen, and editorial fees from Thieme. D. K. Rex is a consultant for Olympus Corporation, Boston Scientific, Medtronic, Aries Pharmaceutical, Braintree Laboratories, Lumendi Ltd., Norgine, Endokey, GI supply, Covidian/Medtronic; research support recipient from EndoAid, Olympus Corporation, Medivators, ERBE USA Inc. Ownerships of Satisfai Health.Ian Grimm is a consultant for Boston Scientific. Matthew T. Moyer is a consultant for Boston Scientific. Muhammad K. Hasan is a consultant for Boston Scientific and Olympus. Douglas Pleskow is a consultant for Olympus, Boston Scientific, and Medtronic. Abraham Mathew is a consultant for Boston Scientific. Harry Aslanian is a consultant for Olympus and Boston Scientific and a speaker for GI Supply. Mouen Khashab is a consultant and on the medical advisory board for Boston Scientific and Olympus, and a consultant for Medtronic. Amit Rastogi is a consultant for Olympus, Cool Endoscopy, and Boston Scientific, and received a research grant from Olympus.Seth Crockett is supported in part by a grant from the NIH (KL2TR001109), and received research funding from Exact Sciences, ColoWrap. Daniel von Renteln is supported by a Fonds de Recherche du Québec Santé career development award, has received research funding from ERBE, Vantage, and Pentax and is a consultant for Boston Scientific. Douglas Pleskow is a consultant for Olympus, Boston Scientific, and Medtronic.