BACKGROUND 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. METHOD 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. RESULTS 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. CONCLUSION 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.

中文翻译：

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一项回顾性队列研究显示，预防性止血钳对内镜后粘膜切除延迟出血的风险对上消化道和下消化道病变的影响。

背景技术内窥镜粘膜切除术（EMR）是用于治疗胃肠道（GI）道中的病变的微创手术。为了防止延迟出血，在EMR期间增加了止血钳的使用。本研究旨在评估止血钳对上，下胃肠道病变EMR后延迟出血的预防作用。方法这是一项回顾性队列研究，使用的是Kaiser Permanente Southern California（KPSC）EMR注册中心。分析了2012年1月至2015年12月接受EMR的上，下胃肠道病变。比较了血夹和非血夹组的延迟出血率。根据上消化道和下消化道病变进行分析。较低的胃肠道组由左右结肠进一步分层。我们在表现出延迟性出血的患者中检查了夹子使用与一些临床相关变量之间的关系。此外，我们探索了可能与夹子使用相关的程序级别和内镜专家级别的特征。结果657个病变中有18个（2.7％）导致延迟出血：止血夹组为7个（1.1％），非血夹蛋白组为11个（1.7％）（p = 0.204）。没有证据表明使用夹子可减轻病变部位出血（p = 0.954）或病变部位（p = 0.997）对延迟出血的可能性的影响。在较低的胃肠道亚组中，施夹不会改变息肉位置（右结肠与左结肠）对延迟出血的可能性的影响（p = 0.951）。Logistic回归分析表明，使用夹子不会改变与下列变量相关的延迟出血的可能性：阿司匹林/ NSAIDs /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，零碎切除。使用的剪辑总数为901，最低额外成本为173,893美元。结论在大规模社区实践中进行的这项回顾性研究中，预防性使用止血夹并不能减少上，下消化道病变的EMR后出血。EMR期间常规应用预防性止血夹可能会导致医疗费用显着增加，而没有明显的临床益处。病理诊断（包括不同类型的结肠息肉样病变），消融，零碎切除。使用的剪辑总数为901，最低额外成本为173,893美元。结论在大规模社区实践中进行的这项回顾性研究中，预防性使用止血夹并不能减少上，下消化道病变的EMR后出血。EMR期间常规应用预防性止血夹可能会导致医疗费用显着增加，而没有明显的临床益处。病理诊断（包括不同类型的结肠息肉样病变），消融，零碎切除。使用的剪辑总数为901，最低额外成本为173,893美元。结论在大规模社区实践中进行的这项回顾性研究中，预防性使用止血夹并不能减少上，下消化道病变的EMR后出血。在EMR期间常规应用预防性止血夹可能会导致医疗费用大幅提高，而没有明显的临床益处。