Tu1477 The Value of Prophylactic Hemoclip Placement in Polypectomy Procedures of Large Pedunculated Polyps: The Experience of a Spanish Community Hospital

The Value of Prophylactic Hemoclip Placement in Polypectomy Procedures of Large Pedunculated Polyps: The Experience of a Spanish Community Hospital Elvira Quintanilla, Cristina Vicente, Jose Luis Castro, Inmaculada Chico, Ana Olivares, Alejandro Ortega, David Collado, Luis Rabago, Jorge E. Carbo, Francisco Gea Gastroenterology, Hospital Universitario Severo Ochoa, Leganes, Spain; Gastroenterology, Instituto de Salud Carlos III, Madrid, Spain INTRODUCTION: A polypectomy is a technique that is not without risk, mainly bleeding and perforation. The methods for preventing post-polypectomy bleeding (PPB) are not standardised and there are groups that use hemoclips for this purpose. OBJECTIVE: To study whether the use of hemoclips reduces PPB complications. MATERIAL AND METHODS: Prospective, randomised study of consecutive patients with pedunculated polyps larger than 10mm, who agreed to participate in the study protocol approved by the hospital’s ethical committee, in compliance with Good Clinical Practice guidelines. The study was also funded by a grant (FIS) received from the Spanish National Department of Health. The patients were included in two groups (hemoclip before polypectomy -HCand standard polypectomy -SP-), between 2007 and 2010. RESULTS: 101 patients were randomised, 3 of which were excluded (2.8%) for failing to meet the inclusion standards, and 35 refused to participate in the study. 105 polypectomies were performed (98 patients), 66 (62.9%) in the HC group and 39 (37.1%) in the SP group. In 10 of the 66 polyps (15.2%), the hemoclip was considered to have been inappropriately placed, mainly due to short pedicles, which gave rise to mucosal burns in 3 patients when the polypectomy snare and hemoclip came in contact with the base of the polyp. The total rate of complications was 10,6% in the HC group [4.5% early bleeding controlled endoscopically without requiring hospital admission, 1.5% severe delayed bleeding (polyp larger than 3cm, which required ICU admission), 4,5% mucosal burns, one of whom developed late perforation (rate of perforation 1.5%) which required surgical treatment and admission to the ICU]. In the SP group, the rate of total complications was 7,7%, and there were no significant differences compared to the HC group (7,7% early bleeding controlled endoscopically without requiring hospital admission). The unexpected increase in morbidity in the HC group made it necessary to suspend the study and the scheduled sample size of 164 patients in each group was not reached. In an ad hoc analysis, which includes the standard polypectomy patients who refused to participate in the study [R group (35 polyps)],the total morbidity was 5,7%, without statistical significance compared to the HC group (no perforations and 2 patients with premature bleeding that was controlled endoscopically).When we compared the morbidity of the HC group to the morbidity of SP group plus R group (74 polyps), we also failed to detect any significant differences in terms of PPB, but did in terms of perforation, which was not evidenced in any of the 74 standard polypectomies. CONCLUSION: The prophylactic use of hemoclips in polypectomies of large pedunculated polyps leads to a further risk of mucosal burns and perforation that is not acceptable, and does not reduce the risk of PPB.