Prophylactic clipping prevents delayed bleeding after endoscopic mucosal resection of large non-ampullary duodenal lateral spreading lesions

Non-ampullary duodenal polyps account for a group of rare tumors of the gastrointestinal tract. Although small lesions are relatively easy to remove, resection of larger lesions requires more advanced techniques such as endoscopic mucosal resection (EMR). Although this technique is considered safe, the most prevalent complication is delayed bleeding (DB) with considerable incidence rates of up to 26%. In this study, we aimed to assess whether prophylactic clipping (PC) reduces DB rates after EMR of large duodenal non-ampullary lateral spreading lesions. We retrospectively collected data from consecutive duodenal EMRs of non-ampullary lateral spreading lesions ≥ 15 mm performed between 2019 and 2022 at two medical centers in the Netherlands and Germany. A total of 186 polyps with a mean size of 25 mm were included in this study. Most were tubular adenomas (55%) and contained low-grade dysplasia (84%). PC of the resection site was performed in 84 patients (45%). The overall DB rate was 13% (24/186). DB occurred in three of 84 cases with PC versus 21 of 102 cases without PC (4% versus 21%, P < 0.01). With an odds ratio of 0.22, multivariable analysis indicated that PC significantly reduced DB (95% confidence interval 0.06–0.85; P = 0.03). PC of the resection site significantly reduced DB after EMR of large non-ampullary duodenal lateral spreading lesions.