1.
Effect of prophylactic clip application for the prevention of postpolypectomy bleeding of large pedunculated colonic polyps: a randomized controlled trial
Gweon TG, Lee KM, Lee SW, Kim DB, Ji JS, Lee JM, Chung WC, Paik CN, Choi H
Gastrointestinal endoscopy. 2021
Abstract
BACKGROUND AND AIMS Prophylactic application of a hemoclip has been suggested as an alternative to the use of an endoloop for the prevention of postpolypectomy bleeding (PPB) when resecting large, pedunculated colorectal polyps. Therefore, this multicenter, randomized controlled trial investigated the efficacy of prophylactic hemoclip application to reduce PPB during the resection of large pedunculated polyps. METHODS Large pedunculated polyps (≥10 mm in head diameter) were eligible for inclusion. Polyps were randomized into a study arm (where clips were applied before resection) and a control arm (without pretreatment). The primary outcome was the rate of PPB in each group. PPB included immediate PPB (IPPB) and delayed PPB (DPPB). IPPB was defined as blood oozing (≥1 min) or active spurting occurring immediately after polyp resection. DPPB was defined as rectal bleeding, occurring after completion of the colonoscopy. RESULTS In total, 238 polyps from 204 patients were randomized into the clip arm (119 polyps) or the control arm (119 polyps). Overall bleeding adverse events were observed in 20 cases (IPPB, n=16; DPPB, n=4). The rate of overall PPB, IPPB and DPPB was 8.4%, 6.7%, and 1.7%, respectively, for all polyps. The rate of overall PPB (clip 4.2% vs control 12.6%, P=0.033) and IPPB (clip 2.5% vs control 10.9%, P=0.017) was significantly lower in the clip arm than the control arm. CONCLUSIONS Prophylactic clipping before resecting large pedunculated polyps can reduce overall PPB and IPPB compared with no prior treatment. Therefore, prophylactic clipping may be considered before resection of large pedunculated polyps. (ClinicalTrials.gov: NCT02156193).
2.
Cost effectiveness of epoetin-alpha to augment preoperative autologous blood donation in elective cardiac surgery
Coyle D, Lee KM, Fergusson DA, Laupacis A
Pharmacoeconomics. 2000;18((2):):161-71.
3.
Economic analysis of erythropoietin use in orthopaedic surgery
Coyle D, Lee KM, Fergusson DA, Laupacis A
Transfusion Medicine. 1999;9((1):):21-30.