Targeted In-Defect Clipping After Colonic Endoscopic Resection: A Prospective Feasibility Study

Background and study aims: Delayed post-polypectomy bleeding (DPPB) remains a significant adverse event following colonic endoscopic resection. Although complete defect closure may reduce bleeding risk, it is often technically challenging. We evaluated the feasibility and safety of a targeted in-defect clipping strategy that does not aim for complete closure. Patients and methods: We conducted a prospective feasibility cohort study of consecutive adult patients undergoing colonic endoscopic resection of lesions ≥30 mm, followed by targeted in-defect clipping (iCLIP) with 3-4 endoclips. Eligible cases involved defects in which complete closure was difficult. The primary endpoint was feasibility, defined as successful deployment of 3–4 clips in ≥90% of cases. Secondary endpoints included DPPB, delayed perforation, post-polypectomy syndrome and post-procedural pain within 30 days. Results: A total of 100 patients were included. Lesions were predominantly right-sided (73%) with a median size of 35 mm. EMR and ESD were performed in 71% and 29% of cases, respectively. The iCLIP strategy was successfully performed in 99% of cases, with one episode of delayed bleeding. No delayed perforation was observed. Post-polypectomy syndrome occurred in one patient and post-procedural pain in eight patients. Conclusions: Targeted in-defect clipping using 3–4 endoclips appears to be a feasible and safe approach for management of challenging post-resection defects and was associated with a very low rate of delayed bleeding in this pilot cohort.