Department of Internal Medicine, School of Medicine, University of California, Riverside, 900 University Avenue, Riverside, CA, 92521, USA.
Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, 4867 W Sunset Blvd, Los Angeles, CA, 90027, USA.
BMC Gastroenterol. 2020 Mar 6;20(1):60. doi: 10.1186/s12876-020-01199-x.
Endoscopic mucosal resection (EMR) is a minimally invasive procedure used for the treatment of lesions in the gastrointestinal (GI) tract. There is increased usage of hemoclips during EMR for the prevention of delayed bleeding. This study aimed to evaluate the effect of hemoclips in the prevention of delayed bleeding after EMR of upper and lower GI tract lesions.
This is a retrospective cohort study using the Kaiser Permanente Southern California (KPSC) EMR registry. Lesions in upper and lower GI tracts that underwent EMR between January 2012 and December 2015 were analyzed. Rates of delayed bleeding were compared between the hemoclip and no-hemoclip groups. Analysis was stratified by upper GI and lower GI lesions. Lower GI group was further stratified by right and left colon. We examined the relationship between clip use and several clinically-relevant variables among the patients who exhibited delayed bleeding. Furthermore, we explored possible procedure-level and endoscopist-level characteristics that may be associated with clip usage.
A total of 18 out of 657 lesions (2.7%) resulted in delayed bleeding: 7 (1.1%) in hemoclip group and 11 (1.7%) in no-hemoclip group (p = 0.204). There was no evidence that clip use moderated the effects of the lesion size (p = 0.954) or lesion location (p = 0.997) on the likelihood of delayed bleed. In the lower GI subgroup, clip application did not alter the effect of polyp location (right versus left colon) on the likelihood of delayed bleed (p = 0.951). Logistic regression analyses showed that the clip use did not modify the likelihood of delayed bleeding as related to the following variables: use of aspirin/NSAIDs/anti-coagulants/anti-platelets, pathologic diagnoses (including different types of colon polypoid lesions), ablation, piecemeal resection. The total number of clips used was 901 at a minimum additional cost of $173,893.
Prophylactic hemoclip application did not reduce delayed post-EMR bleed for upper and lower GI lesions in this retrospective study performed in a large-scale community practice setting. Routine prophylactic hemoclip application during EMR may lead to significantly higher healthcare cost without a clear clinical benefit.
内镜黏膜切除术（EMR）是一种用于治疗胃肠道（GI）道病变的微创程序。在 EMR 中，使用止血夹可预防延迟性出血。本研究旨在评估止血夹在预防上、下 GI 道病变 EMR 后延迟性出血中的作用。
这是一项使用 Kaiser Permanente Southern California（KPSC）EMR 注册中心的回顾性队列研究。分析了 2012 年 1 月至 2015 年 12 月期间接受 EMR 的上、下 GI 道病变。比较了止血夹组和无止血夹组的延迟性出血发生率。根据上 GI 和下 GI 病变对分析进行分层。下 GI 组进一步按右结肠和左结肠分层。我们检查了在出现延迟性出血的患者中，夹的使用与几个临床相关变量之间的关系。此外，我们还探讨了可能与夹的使用相关的程序水平和内镜医生水平的特征。
总共 657 个病变中有 18 个（2.7%）发生延迟性出血：止血夹组 7 个（1.1%），无止血夹组 11 个（1.7%）（p=0.204）。没有证据表明夹的使用会影响病变大小（p=0.954）或病变位置（p=0.997）对延迟性出血可能性的影响。在下 GI 亚组中，夹的应用并没有改变息肉位置（右结肠与左结肠）对延迟性出血可能性的影响（p=0.951）。逻辑回归分析表明，夹的使用并没有改变与以下变量相关的延迟性出血的可能性：阿司匹林/非甾体抗炎药/抗凝剂/抗血小板的使用、病理诊断（包括不同类型的结肠息肉样病变）、消融、分片切除。总共使用了 901 个夹，额外增加了 173893 美元的成本。
在这项回顾性研究中，在大规模社区实践环境中，预防性使用止血夹并不能减少上、下 GI 道病变 EMR 后的延迟性出血。在 EMR 中常规预防性使用止血夹可能会导致显著增加医疗成本，而没有明显的临床获益。
