Efficacy of Prophylactic Hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps

Linda A Feagins, Andrew D. Smith, Daniel Kim, Akeel Halai, Suneetha Duttala, Benjamin Chebaa, Tisha Lunsford, John Vizuete, Miriam Mara, Ranjan Mascarenhas, Rabia Meghani, Leon Kundrotas, Kerry E Dunbar, Daisha J. Cipher, William V Harford, Stuart J Spechler

Research output: Contribution to journalArticle

Abstract

Background & Aims: The efficacy of prophylactic placement of hemoclips to prevent delayed bleeding after removal of large colonic polyps has not been established. We conducted a randomized equivalence study to determine whether prophylactic placement of hemoclips affects incidence of delayed post-polypectomy bleeding (PPB). Methods: During elective colonoscopy performed at 4 Veterans Affairs Medical Centers, 1098 patients who had polyps ≥1 cm removed were randomly assigned to groups that received prophylactic hemoclips (n = 547) or no hemoclips (n = 551), from September 2011 through September 2018. Data on PPB (rectal bleeding resulting in hemoglobin decreases ≥2 g/dL, hemodynamic instability, colonoscopy, angiography, or surgery) within 30 days of colonoscopy (called delayed PPB) were collected during telephone interviews or hospital visits 7 and 30 days after colonoscopy. The primary outcome was the incidence of important post-polypectomy bleeding. Results: Twelve patients in the hemoclip group (2.3%) and 15 patients in the no hemoclip group (2.9%) had important delayed PPB. There were no deaths, and no patients in either group required angiography or surgery. In intention-to-treat analysis, two 1-sided test's lower and upper confidence interval limits were –2.07 and 1.01, indicating that the data approached but did not meet equivalence criteria. On multiple logistic regression analysis, significant predictors of PPB included use of warfarin with bridging, thienopyridines, polyp size, and polyp location, but hemoclip placement did not associate with important delayed PPB. Conclusions: In a randomized trial, we found that prophylactic placement of hemoclips after removal of large colon polyps does not affect the proportion of important delayed PPB events, compared with no hemoclip placement. These findings call into question the widespread, expensive practice of routinely placing prophylactic hemoclips after polypectomy. ClinicalTrials.gov ID: NCT01647581.

Original languageEnglish (US)
Pages (from-to)967-976.e1
JournalGastroenterology
Volume157
Issue number4
DOIs
StatePublished - Oct 1 2019

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Colonic Polyps
Hemorrhage
Colonoscopy
Polyps
Angiography
Thienopyridines
Intention to Treat Analysis
Incidence
Veterans
Warfarin
Colon
Hemoglobins
Logistic Models
Hemodynamics
Regression Analysis
Confidence Intervals
Interviews

Keywords

  • Colonoscopy
  • Gastrointestinal Hemorrhage
  • Polypectomy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Efficacy of Prophylactic Hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps. / Feagins, Linda A; Smith, Andrew D.; Kim, Daniel; Halai, Akeel; Duttala, Suneetha; Chebaa, Benjamin; Lunsford, Tisha; Vizuete, John; Mara, Miriam; Mascarenhas, Ranjan; Meghani, Rabia; Kundrotas, Leon; Dunbar, Kerry E; Cipher, Daisha J.; Harford, William V; Spechler, Stuart J.

In: Gastroenterology, Vol. 157, No. 4, 01.10.2019, p. 967-976.e1.

Research output: Contribution to journalArticle

Feagins, LA, Smith, AD, Kim, D, Halai, A, Duttala, S, Chebaa, B, Lunsford, T, Vizuete, J, Mara, M, Mascarenhas, R, Meghani, R, Kundrotas, L, Dunbar, KE, Cipher, DJ, Harford, WV & Spechler, SJ 2019, 'Efficacy of Prophylactic Hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps', Gastroenterology, vol. 157, no. 4, pp. 967-976.e1. https://doi.org/10.1053/j.gastro.2019.05.003
Feagins, Linda A ; Smith, Andrew D. ; Kim, Daniel ; Halai, Akeel ; Duttala, Suneetha ; Chebaa, Benjamin ; Lunsford, Tisha ; Vizuete, John ; Mara, Miriam ; Mascarenhas, Ranjan ; Meghani, Rabia ; Kundrotas, Leon ; Dunbar, Kerry E ; Cipher, Daisha J. ; Harford, William V ; Spechler, Stuart J. / Efficacy of Prophylactic Hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps. In: Gastroenterology. 2019 ; Vol. 157, No. 4. pp. 967-976.e1.
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AU - Smith, Andrew D.

AU - Kim, Daniel

AU - Halai, Akeel

AU - Duttala, Suneetha

AU - Chebaa, Benjamin

AU - Lunsford, Tisha

AU - Vizuete, John

AU - Mara, Miriam

AU - Mascarenhas, Ranjan

AU - Meghani, Rabia

AU - Kundrotas, Leon

AU - Dunbar, Kerry E

AU - Cipher, Daisha J.

AU - Harford, William V

AU - Spechler, Stuart J

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N2 - Background & Aims: The efficacy of prophylactic placement of hemoclips to prevent delayed bleeding after removal of large colonic polyps has not been established. We conducted a randomized equivalence study to determine whether prophylactic placement of hemoclips affects incidence of delayed post-polypectomy bleeding (PPB). Methods: During elective colonoscopy performed at 4 Veterans Affairs Medical Centers, 1098 patients who had polyps ≥1 cm removed were randomly assigned to groups that received prophylactic hemoclips (n = 547) or no hemoclips (n = 551), from September 2011 through September 2018. Data on PPB (rectal bleeding resulting in hemoglobin decreases ≥2 g/dL, hemodynamic instability, colonoscopy, angiography, or surgery) within 30 days of colonoscopy (called delayed PPB) were collected during telephone interviews or hospital visits 7 and 30 days after colonoscopy. The primary outcome was the incidence of important post-polypectomy bleeding. Results: Twelve patients in the hemoclip group (2.3%) and 15 patients in the no hemoclip group (2.9%) had important delayed PPB. There were no deaths, and no patients in either group required angiography or surgery. In intention-to-treat analysis, two 1-sided test's lower and upper confidence interval limits were –2.07 and 1.01, indicating that the data approached but did not meet equivalence criteria. On multiple logistic regression analysis, significant predictors of PPB included use of warfarin with bridging, thienopyridines, polyp size, and polyp location, but hemoclip placement did not associate with important delayed PPB. Conclusions: In a randomized trial, we found that prophylactic placement of hemoclips after removal of large colon polyps does not affect the proportion of important delayed PPB events, compared with no hemoclip placement. These findings call into question the widespread, expensive practice of routinely placing prophylactic hemoclips after polypectomy. ClinicalTrials.gov ID: NCT01647581.

AB - Background & Aims: The efficacy of prophylactic placement of hemoclips to prevent delayed bleeding after removal of large colonic polyps has not been established. We conducted a randomized equivalence study to determine whether prophylactic placement of hemoclips affects incidence of delayed post-polypectomy bleeding (PPB). Methods: During elective colonoscopy performed at 4 Veterans Affairs Medical Centers, 1098 patients who had polyps ≥1 cm removed were randomly assigned to groups that received prophylactic hemoclips (n = 547) or no hemoclips (n = 551), from September 2011 through September 2018. Data on PPB (rectal bleeding resulting in hemoglobin decreases ≥2 g/dL, hemodynamic instability, colonoscopy, angiography, or surgery) within 30 days of colonoscopy (called delayed PPB) were collected during telephone interviews or hospital visits 7 and 30 days after colonoscopy. The primary outcome was the incidence of important post-polypectomy bleeding. Results: Twelve patients in the hemoclip group (2.3%) and 15 patients in the no hemoclip group (2.9%) had important delayed PPB. There were no deaths, and no patients in either group required angiography or surgery. In intention-to-treat analysis, two 1-sided test's lower and upper confidence interval limits were –2.07 and 1.01, indicating that the data approached but did not meet equivalence criteria. On multiple logistic regression analysis, significant predictors of PPB included use of warfarin with bridging, thienopyridines, polyp size, and polyp location, but hemoclip placement did not associate with important delayed PPB. Conclusions: In a randomized trial, we found that prophylactic placement of hemoclips after removal of large colon polyps does not affect the proportion of important delayed PPB events, compared with no hemoclip placement. These findings call into question the widespread, expensive practice of routinely placing prophylactic hemoclips after polypectomy. ClinicalTrials.gov ID: NCT01647581.

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