Temple University School of Medicine Philadelphia, PA
Marina Baskharoun, MD1, Neil Sood, MD1, Gregory Piech, MD, MPH2, Saraswathi Cappelle, MD1, Woo Jung Lee, MD1, Stephen Heller, MD2, Frank Friedenberg, MD, MS (Epi)2; 1Temple University School of Medicine, Philadelphia, PA; 2Temple University Hospital, Philadelphia, PA
Introduction: Colonic polypectomy (CP) is performed to remove precancerous or early cancerous polyps to decrease the risk of invasive colon cancer. The primary complications of CP are post-polypectomy bleeding and perforation. In the hope of decreasing the incidence of these complications, endoscopists may deploy temporary endoscopic clips at the CP site. However, data supporting the efficacy of this practice is mixed and clips are very expensive ranging $150 - $200 per clip. The aims of this study were to investigate patterns of endoscopic clip placement at our institution and to assess factors which influence the placement of clips. Methods: Retrospective analysis evaluated 3,283 CPs at our institution from 1/1/2019 – 12/31/2019. Variables recorded included polyp size, location, method of polyp removal, and antiplatelet use. In addition, the training level of the attending (general vs advanced) was noted as well as time of day (AM vs PM), presence of a fellow, and day of week. Results: Among the 3,283 CPs analyzed, male patients comprised 50.4% of the cases, mean age 62.2y. Mean polyp size was 6 mm (range 1-40 mm). 40.7% of polyps were right sided. Overall, in 215 (6.5%) CPs a clip was placed. On univariate analysis only polyp size, method of removal (forceps v. cold snare v. hot snare v. mucosal lift endoscopic mucosal resection (EMR)), and role as an advanced endoscopist (9.8 v. 5.6% of cases) were associated with clip placement. However, on multivariate analysis there was no association with patient age, gender, presence of a fellow, anti-platelet use, location of polyp, day of the week, or time of day. Logistic regression modeling revealed that for each 1 mm increase in polyp size, OR = 1.18 (1.13- 1.23) for clip placement. Method of removal was highly associated with clip placement using forceps removal as the reference method; (cold snare, OR = 2.7 (1.5-4.7), hot snare, OR = 3.1 (1.6-6.0), mucosal lift EMR, OR = 16.2 (7.7-34.0)). Advanced endoscopist status was not associated with clip placement; OR = 1.4 (0.9-2.0). Discussion: Increased polyp size and method of removal are significantly associated with clip placement. This makes sense in that the risk of injuring a submucosal artery is increased when a large amount of tissue is removed. Location of polyp, day of the week, anti-platelet use and advanced endoscopist status were not associated with clip placement.
Disclosures: Marina Baskharoun indicated no relevant financial relationships. Neil Sood indicated no relevant financial relationships. Gregory Piech indicated no relevant financial relationships. Saraswathi Cappelle indicated no relevant financial relationships. Woo Jung Lee indicated no relevant financial relationships. Stephen Heller indicated no relevant financial relationships. Frank Friedenberg indicated no relevant financial relationships.