Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events

Abstract

Background: Clip closure of large colorectal mucosal defects may reduce the rate of adverse events in a cost-effective manner.

Objective: To assess the adverse events and outcomes of clip closure of defects after endoscopic resection in patients with large colorectal tumors.

Design: Prospective, randomized, controlled study.

Setting: Single tertiary referral center.

Patients and interventions: Patients with lesions measuring 1 to 4 cm who were scheduled for endoscopic resection between March 2012 and December 2014 were randomly assigned to a clip-closure group and a no-closure group. In the clip-closure group, the defect of the resection site was completely closed with an endoclip. In the no-closure group, the defect was left open. The following primary outcome measures were assessed: delayed postoperative bleeding, postpolypectomy coagulation syndrome, perforation, and abdominal pain. Secondary outcome measures of length of hospital stay, time required for procedure, and patient's satisfaction were also assessed.

Results: Patients and lesions had similar characteristics across both groups. For patients who underwent clip closure (n = 174), the rates of delayed postoperative bleeding (1.1% [2/174]) and postpolypectomy coagulation syndrome (0.6% [1/174]) were lower than those in the no-closure group (6.9% [12/174], P = .01 and 4.6% [8/174], P = .03). Two patients experienced perforation, 1 in each group. In the clip-closure group, 4 patients reported abdominal pain as opposed to 26 in the no-closure group (2.8% vs 16.7%, P < .01). The procedure took longer in the closure group (38.1 minutes vs 30.9 minutes, P = .04). The length of hospitalization was shorter in the closure group (3.1 days vs 4.7 days, P = .03). Total medical expense was similar between the 2 groups. Patients who underwent closure reported greater satisfaction.

Limitation: This was a single-center analysis.

Conclusions: Clip closure of endoscopic resection defects in patients with large colorectal tumors decreased the rate of procedure-related adverse events and did not increase the cost of hospitalization.