Australia: Prophylactic clip closure reduces the risk of clinically significant post-EMR (endoscopic mucosal resection) bleeding and can be performed following the EMR of large non-pedunculated colorectal polyps of 20 mm or larger in the right colon, says a recent study. The study appears in the journal The Lancet Gastroenterology & Hepatology.
Endoscopic mucosal resection is the mainstay for the management of large (≥20 mm) non-pedunculated colorectal polyps. In about 7% of the cases, clinically significant post-EMR bleeding occurs and is most frequently encountered in the right colon. Considering this, Sunil Gupta, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia, and colleagues aimed to assess the utility of prophylactic clip closure in preventing clinically significant post-EMR bleeding within the right colon.

For this purpose, the researchers conducted a randomized controlled trial at a tertiary center in Australia. Patients referred for the EMR of large non-pedunculated colorectal polyps in the right colon were deemed eligible. 231 Patients were randomly assigned in the ratio of 1:1 to receive a clip (n=118) or control (no clip; n=113) group.
Clinically significant post-EMR bleeding, defined as haematochezia necessitating emergency department presentation, hospitalisation, or re-intervention within 14 days post-EMR was the primary endpoint.
Key findings include:
In the intention-to-treat analysis, clinically significant post-EMR bleeding was less frequent in the clip group than in the control group (four [3·4%] of 118 patients vs 12 [10·6%] of 113; absolute risk reduction 7·2%; number needed to treat 13·9).
There were no differences between groups in adverse events, including delayed perforation (one [<1%] in the clip group vs one [<1%] in the control group) and post-EMR pain (four [3%] vs six [5%]).
No deaths were reported.
"Prophylactic clip closure can be performed after the EMR of large non-pedunculated colorectal polyps of 20 mm or larger in the right colon to reduce the risk of clinically significant post-EMR bleeding and should be adopted as a standard of care," the authors concluded.
Reference:
Gupta S, Sidhu M, Shahidi N, et al. Effect of prophylactic endoscopic clip placement on clinically significant post-endoscopic mucosal resection bleeding in the right colon: a single-centre, randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7(2):152-160. doi: 10.1016/S2468-1253(21)00384-8