Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Republic of Korea.
Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
BMC Gastroenterol. 2020 Mar 12;20(1):68. doi: 10.1186/s12876-020-01210-5.
Although prophylactic clip application before polypectomy may prevent postpolypectomy bleeding (PPB), the usefulness of prophylactic clipping in the treatment of large pedunculated polyps is controversial in some prospective randomized studies. This study was conducted to evaluate the efficacy of prophylactic clip application and to investigate the predictors of PPB in large pedunculated colorectal polyps.
A total of 137 pedunculated polyps (size ≥1 cm) in 116 patients were prospectively included and randomized into group A (with clipping) and group B (without clipping), and resected. The occurrences of immediate PPB (graded 1-4) and delayed PPB were compared.
Sixty-seven polyps were allocated in group A and 70 polyps in group B. In both groups, the median polyp diameter was 15 mm (P = 0.173) and the median stalk diameter was 3 mm (P = 0.362). Twenty-eight (20.4%) immediate PPB episodes in 137 polyps occurred, 6 (9.0%) in group A and 22 (31.4%) in group B (P = 0.001). However, the occurrence of delayed PPB was not different between the groups (P = 0.943). Prophylactic clip application decreased the occurrence of immediate PPB (odds ratio 0.215, 95% confidence interval 0.081-0.571). Moreover, polyp size ≥20 mm and stalk diameter ≥ 4 mm increased the risk of immediate PPB.
Clip application before polypectomy of ≥1 cm pedunculated polyps is effective in decreasing the occurrence of immediate PPB. Thus, clip application should be considered before performing snare polypectomy, especially for large polyps with a thick stalk.
This research was studied a prospective maneuver and enrolled in a registry of clinical trials run by United States National Library of Medicine at the National Institutes of Health (ClinicalTrials.gov Protocol Registration and Results system ID: NCT01437631). This study was registered on September 19, 2011.
虽然息肉切除术前预防性夹闭可以预防息肉切除术后出血（PPB），但在一些前瞻性随机研究中，预防性夹闭在治疗大型有蒂息肉中的作用仍存在争议。本研究旨在评估预防性夹闭的疗效，并探讨大型有蒂结直肠息肉发生 PPB 的预测因素。
前瞻性纳入并随机分为 A 组（夹闭组）和 B 组（未夹闭组）的 116 例患者的 137 个有蒂息肉（大小≥1cm），切除后比较即刻 PPB（1-4 级）和迟发性 PPB 的发生情况。
A 组 67 个息肉，B 组 70 个息肉。两组息肉直径中位数均为 15mm（P=0.173），息肉蒂直径中位数均为 3mm（P=0.362）。137 个息肉中，28 个（20.4%）发生即刻 PPB，A 组 6 个（9.0%），B 组 22 个（31.4%）（P=0.001）。然而，两组迟发性 PPB 的发生无差异（P=0.943）。预防性夹闭可降低即刻 PPB 的发生（比值比 0.215，95%置信区间 0.081-0.571）。此外，息肉大小≥20mm 和蒂直径≥4mm 增加了即刻 PPB 的风险。
对≥1cm 有蒂息肉行息肉切除术前夹闭可有效降低即刻 PPB 的发生。因此，对于大息肉或蒂较粗的息肉，在进行圈套切除术之前应考虑夹闭。
本研究为前瞻性操作，在美国国立卫生研究院（美国国立图书馆医学临床试验注册和结果系统 ID：NCT01437631）注册的临床试验注册库中进行。本研究于 2011 年 9 月 19 日注册。
