Background & Aims

Serrated polyps are important colorectal cancer precursors and are most commonly located in the proximal colon, where post-polypectomy bleeding rates are higher. There is limited clinical trial evidence to guide best practices for resection of large serrated polyps (LSPs).

Methods

In a multicenter trial, patients with large (≥20 mm) non-pedunculated polyps undergoing endoscopic mucosal resection (EMR) were randomized to clipping of the resection base or no clipping. This analysis is stratified by histologic subtype of study polyp(s), categorized as serrated [sessile serrated lesions (SSLs) or hyperplastic polyps (HPs)] or adenomatous, comparing clip vs control groups. The primary outcome was severe post-procedure bleeding within 30 days of colonoscopy.

Results

A total of 179 participants with 199 LSPs (191 SSLs and 8 HPs) and 730 participants with 771 adenomatous polyps were included in the study. Overall, 5 patients with LSPs (2.8%) experienced post-procedure bleeding compared with 42 (5.8%) of those with adenomas. There was no difference in post-procedure bleeding rates between patients in the clip vs control group among those with LSPs (2.3% vs 3.3%, respectively, difference 1.0%; P = NS). However, among those with adenomatous polyps, clipping was associated with a lower risk of post-procedure bleeding (3.9% vs 7.6%, difference 3.7%; P = .03) and overall serious adverse events (5.5% vs 10.6%, difference 5.1%; P = .01).

Conclusion

The post-procedure bleeding risk for LSPs removed via EMR is low, and there is no discernable benefit of prophylactic clipping of the resection base in this group. This study indicates that the benefit of endoscopic clipping following EMR may be specific for >2 cm adenomatous polyps located in the proximal colon.

ClinicalTrials.gov, Number: NCT01936948.

中文翻译：

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夹闭并不能降低大锯齿状息肉切除后出血的风险：随机试验的结果

背景与目标

锯齿状息肉是结直肠癌的重要前兆，最常见于近端结肠，息肉切除术后出血率较高。指导切除大锯齿状息肉 (LSP) 最佳实践的临床试验证据有限。

方法

在一项多中心试验中，接受内镜黏膜切除术 (EMR) 的大（≥20 mm）无蒂息肉患者被随机分为切除基底夹闭组或不夹闭组。该分析按研究息肉的组织学亚型进行分层，分类为锯齿状 [无蒂锯齿状病变 (SSL) 或增生性息肉 (HP)] 或腺瘤，比较夹片组与对照组。主要结果是结肠镜检查后 30 天内出现严重的术后出血。

结果

共有 179 名参与者与 199 个 LSP（191 个 SSL 和 8 个 HP）和 730 名参与者与 771 个腺瘤性息肉被纳入研究。总体而言，5 例 LSP 患者 (2.8%) 经历了术后出血，而腺瘤患者为 42 例 (5.8%)。在 LSP 患者中，夹闭组患者与对照组患者的术后出血率没有差异（分别为 2.3% 和 3.3%，差异 1.0%；P  = NS）。然而，在腺瘤性息肉患者中，夹闭与较低的术后出血风险相关（3.9% vs 7.6%，差异 3.7%；P  = .03）和总体严重不良事件（5.5% vs 10.6%，差异 5.1） %；P  = .01)。

结论

通过 EMR 切除的 LSP 的术后出血风险较低，并且在该组中预防性夹闭切除基底没有明显的益处。这项研究表明，EMR 后内镜夹闭的益处可能对位于近端结肠的 > 2 cm 腺瘤性息肉具有特异性。

ClinicalTrials.gov，编号：NCT01936948。