Abstract
Background
With the recent, widespread availability of endoscopic hemoclips, it has become common clinical practice to apply hemoclips to some non-bleeding polypectomy sites “prophylactically” to prevent delayed post-polypectomy bleeding (PPB). Few published data support this practice, however.
Aim
The aim of this study was to compare rates of delayed PPB in matched patients who had polypectomies performed with and without the prophylactic placement of hemoclips.
Methods
We reviewed medical records of patients who had elective colonoscopy at our VA Medical Center between July 2008 and December 2009. We identified patients who had hemoclips applied prophylactically (cases) and compared their rate of delayed PPB within 30 days to that of patients who had polypectomy without hemoclipping (controls). Controls were matched 1:1 to cases based on age and on factors known to contribute to the risk of PPB including polyp size, morphology, technique of polyp removal, number of polyps removed, and use of anticoagulants.
Results
We identified 184 patients (cases) who underwent prophylactic hemoclipping and 184 well-matched controls. An average of 3.8 polyps per patient were removed in the case group compared to 3.3 polyps per patient in controls (p = 0.6). Delayed PPB occurred in three patients in the prophylactic hemoclip group and in one patient in the control group (1.6 vs. 0.5 %, p = 0.62).
Conclusions
We found no significant difference in the rate of delayed PPB between patients who had prophylactic hemoclipping of polypectomy sites and a well-matched control group of patients who had polypectomy without prophylactic hemoclipping. These data call into question the expensive practice of prophylactic hemoclipping.
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Acknowledgments
This work was supported by the Office of Medical Research, Department of Veteran’s Affairs.
Conflict of interest
Dr. Feagins has received research funding from Altheus Therapeutics for an unrelated project. Dr. Spechler is a consultant for Torax Medical Inc., Ironwood Pharmaceuticals Inc., and Takeda Pharmaceuticals Inc.; however, none of these are relevant to this article. A.D.N. and R.I. have nothing to disclose.
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Feagins, L.A., Nguyen, A.D., Iqbal, R. et al. The Prophylactic Placement of Hemoclips to Prevent Delayed Post-polypectomy Bleeding: An Unnecessary Practice? A Case Control Study. Dig Dis Sci 59, 823–828 (2014). https://doi.org/10.1007/s10620-014-3055-0
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DOI: https://doi.org/10.1007/s10620-014-3055-0