Masterclass Colonoscopy: Trends and Recommendations Forward (Virtual) | February 2024-When to Clip, When Not to clip, How to Clip, X-tack

When to Clip, When Not to clip, How to Clip, X-tack

Pdf Summary

This document discusses the use of closure techniques, specifically clipping, in preventing delayed bleeding after procedures such as colonoscopies. The study mentioned in the document compared the use of microprocessor-controlled forced coagulation to ERBE Endocut 2-1-4 and found that there was no significant difference in the risk of delayed bleeding. However, there was an increase in immediate bleeding and a possible increase in the risk of perforation. The document also highlights the implications of delayed bleeding, including the associated costs of hospitalization, medical-legal risks, and reputational risks. <br /><br />The document also explores whether prophylactic clipping is effective. Several studies show that clipping can be effective in reducing bleeding rates in patients, particularly for lesions larger than 20 mm in the proximal colon. Meta-analyses and cost-analyses support the use of clipping, indicating its cost-effectiveness for high-risk lesions. <br /><br />The document mentions the Clipper Study, which was conducted in 19 Dutch hospitals and involved patients with proximal colon lesions larger than 20 mm. The study found that clip closure resulted in a higher bleed rate compared to non-clipped closure. <br /><br />The document briefly touches on different techniques and tools for clip closure, including the MANTIS Closure Clip and X-tack. It also mentions the importance of properly resecting large pedunculated lesions and closing left-sided defects. <br /><br />Lastly, the document discusses different types of clip artifacts, which can be seen during colonoscopies. These artifacts range from attached clips without inflammation to residual adenoma. <br /><br />Overall, the document provides an overview of closure techniques, specifically clipping, and their effectiveness in preventing bleeding after procedures such as colonoscopies.

Keywords

closure techniques

clipping

delayed bleeding

colonoscopies

prophylactic clipping

bleeding rates

lesions larger than 20 mm

Clipper Study

clip artifacts

residual adenoma