The Effect Of Endoclip And Endoloop On Preventing Post-polypectomy Bleeding Of Large Colorectal Polyps And Analysis Of Risk Factors

Objective Bleeding is the most common complication of polypectomy.Endoclip and endoloop are crucial instruments for hemostasis and can be applied to ligate the stalk in order to prevent post-polypectomy bleeding before resecting large pedunculated colorectal polyps.Meanwhile,endoclips can also be used to close the incision after removing the polyps to prevent post-polypectomy bleeding.We retrospectively collected and analyzed cases of polypectomy to investigate the hemostasis effect of endoclips and endoloops for large colorectal polyps.Methods Data of patients who underwent polypectomy during January 2003 to March 2016 were retrospectively collected.The diameters of all the polyps were not less than 10mm.Cases were divided into four groups.Before large pedunculated(with stalks)polyps were resected,endoclips were used to ligate the stalk of polyp(Group A),and endoloops were used(Group B).For polyps without ligation before resection,endoclips were used to close the incision of polypectomy(Group C),and endoclips were not used(Group D).The immediate and delayed postpolypectomy bleeding rate were calculated and compared and the clinicopathologic features as well as risk factors for post-polypectomy bleeding were analyzed.We searched articles about endoclip or endoloop on preventing post-polypectomy bleeding of recent five years in PubMed and analyzed the characteristics of these articles.Result 2006 polyps were included.Endoclips were used to ligate the stalk in 147 polyps(Group A).The mean diameter of Group A was 21.8mm and the immediate bleeding rate of Group A was 3.4%(5/147),and the delayed bleeding rate was 6.1%(9/147).Endoloops were used to ligate the pedicle in 132 polyps(Group B).The mean diameter of Group B was 27.5mm and the immediate bleeding rate of Group B was 3.8%(5/132),and the delayed bleeding rate was 7.6%(10/132).There were no significant differences of bleeding rates between the two groups.All the cases with bleeding were managed by endoscopic methods without turning to surgery.No perforations happened in these cases.In the univariate and multivariate analysis of risk factors,age,sex,diameter,location,histology,atypia,bleeding before and during polypectomy did not affect delayed post-polypectomy bleeding(P>0.05).1727 large sessile and pedunculated polyps were resected.Endoclips were used to close the incision of polypectomy in 888 polyps(Group C)and the mean diameter of Group C was 18.13mm.The delayed bleeding rate of Group C was 3.2%(28/888).Endoclips were not used to close the incision of polypectomy in 839 polyps(Group D).The mean diameter of Group D was 17.11mm.The delayed bleeding rate of Group D was 1.9%(16/839).There were no differences of bleeding rates between different shapes and diameters(P>0.05).None of the bleeding cases needed operation.No perforations happened.In the univariate analysis of risk factors,age and stalk can affect delayed bleeding(P<0.05).In the multivariate analysis,older age(OR=0.972,P=0.021)and polyps in the right colon(OR=0.333,P=0.031)were protective factors for delayed bleeding.Six articles about endoclip or endoloop on preventing post-polypectomy bleeding were extracted from PubMed and included into analysis.Most of the articles revealed that endoclip and endoloop were effective tools in prevention of postpolypectomy bleeding.Conclusion Endoclips and endoloops can be used to ligate the stalk of polyps before resection and had the same hemostasis effect.For polyps without ligation before resection,endoclips can not decrease the delayed bleeding rate.