Clip Closure After Resection of Large Colorectal Lesions With Substantial Risk of Bleeding
Por:
Albeniz, E, Alvarez, MA, Espinos, JC, Nogales, O, Guarner, C, Alonso, P, Rodriguez-Tellez, M, de Tejada, AH, Santiago, J, Bustamante-Balen, M, Sanchez, JR, Ramos-Zabala, F, Valdivielso, E, Martinez-Alcala, F, Fraile, M, Elosua, A, Veloz, MFG, Beroiz, BI, Capdevila, F, Enguita-German, M
Publicada:
1 nov 2019
Resumen:
BACKGROUND & AIMS: It is not clear whether closure of mucosal defects with clips after colonic endoscopic mucosal resection (EMR) prevents delayed bleeding, although it seems to have no protective effects when risk is low. We performed a randomized trial to evaluate the efficacy of complete clip closure of large (>= 2 cm) nonpedunculated colorectal lesions after EMR in patients with an estimated average or high risk of delayed bleeding. METHODS: We performed a single-blind trial at 11 hospitals in Spain from May 2016 through June 2018, including 235 consecutive patients who underwent EMR for large nonpedunculated colorectal lesions with an average or high risk of delayed bleeding (based on Spanish Endoscopy Society Endoscopic Resection Group score). Participants were randomly assigned to groups that received closure of the scar with 11-mm through-the-scope clips (treated, n = 119) or no clip (control, n = 116). The primary outcome was proportion of patients in each group with delayed bleeding, defined as evident hematochezia that required medical intervention within 15 days after colonoscopy. RESULTS: In the clip group, complete closure was achieved in 68 (57%) cases, with partial closure in 33 (28%) cases and failure to close in 18 (15%) cases. Delayed bleeding occurred in 14 (12.1%) patients in the control group and in 6 (5%) patients in the clip group (absolute risk difference, reduction of 7% in the clip group; 95% confidence interval, -14.7% to 0.3%). After completion of the clip closure, there was only 1 (1.5%) case of delayed bleeding (absolute risk difference, reduction of 10.6%; 95% confidence interval, -4.3% to 17.9%). CONCLUSIONS: In a randomized trial of patients with large nonpedunculated colorectal lesions undergoing EMR, we found that clip closure of mucosal defects in patients with a risk of bleeding can be a challenge, but also reduces delayed bleeding. Prevention of delayed bleeding required complete clip closure.
Filiaciones:
Albeniz, E:
Complejo Hosp Navarra, Pamplona, Spain
Alvarez, MA:
Hosp del Mar, Barcelona, Spain
Espinos, JC:
Hosp Univ Mutua Terrassa, Barcelona, Spain
Nogales, O:
Hosp Gregorio Maranon, Madrid, Spain
Guarner, C:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Alonso, P:
Hosp Juan Canalejo, La Coruna, Spain
Rodriguez-Tellez, M:
Hosp Univ Virgen Macarena, Seville, Spain
de Tejada, AH:
Hosp Univ Puerta de Hierro, Madrid, Spain
Santiago, J:
Hosp Univ Puerta de Hierro, Madrid, Spain
Bustamante-Balen, M:
Hosp Univ La Fe, Valencia, Spain
Sanchez, JR:
Hosp Gen Ciudad Real, Ciudad Real, Spain
Ramos-Zabala, F:
Hosp Univ HM Monteprincipe, HM Hosp, Madrid, Spain
Valdivielso, E:
Hosp Juan Canalejo, La Coruna, Spain
Martinez-Alcala, F:
Clin Gastroenterol Integral, Seville, Spain
Fraile, M:
Hosp San Pedro Logrono, Logrono, Spain
Elosua, A:
Complejo Hosp Navarra, Pamplona, Spain
Veloz, MFG:
Hosp Univ Virgen Macarena, Seville, Spain
Beroiz, BI:
Univ Publ Navarra, Navarrabiomed, Inst Investigac Sanitaria Navarra, Red Invest Serv Sanitarios & Enfermedades Cron, Pamplona, Spain
Capdevila, F:
Univ Publ Navarra, Navarrabiomed, Inst Investigac Sanitaria Navarra, Pamplona, Spain
Enguita-German, M:
Univ Publ Navarra, Navarrabiomed, Inst Investigac Sanitaria Navarra, Pamplona, Spain
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