Endoscopy 2020; 52(S 01): S113
DOI: 10.1055/s-0040-1704348
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 08:30 – 10:30 Large colonic polyps: Slice and dice The Liffey B
© Georg Thieme Verlag KG Stuttgart · New York

TO CLIP OR NOT TO CLIP AFTER EMR OF LARGE NONPEDUNCULATED COLORECTAL POLYPS. COST-EFFECTIVENESS ANSWERS BASED ON REAL DATA

E Albeniz-Arbizu
1   Complejo Hospitalario de Navarra, Pamplona, Spain
,
G Gonzalez-Gete
1   Complejo Hospitalario de Navarra, Pamplona, Spain
,
MA Alvarez
2   Hospital del Mar, Barcelona, Spain
,
F Estremera-Arevalo
1   Complejo Hospitalario de Navarra, Pamplona, Spain
,
JC Espinos
3   Hospital Universitari Mútua Terrassa, Terrassa, Spain
,
AZ Gimeno-García
4   Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
,
AH de Tejada
5   Hospital Universitario Puerta de Hierro, Madrid, Spain
,
J Rodríguez-Sánchez
6   Hospital Universitario 12 de Octubre, Madrid, Spain
,
P Roson
7   Hospital Quirón, Malaga, Spain
,
C Guarner
8   Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
JC Marin
6   Hospital Universitario 12 de Octubre, Madrid, Spain
,
B Ibañez-Beroiz
9   Navarrabiomed-UPNA-IDISNA-REDISSEC, Pamplona, Spain
,
M Enguita-Germán
10   Navarrabiomed, Pamplona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Delayed bleeding (DB) is the most common serious complication of EMR. Two randomized clinical trials have recently demonstrated that clip closure of mucosal defects after large nonpedunculated colorectal polyps (LNPCP) reduces the risk of DB. We aimed to analyze the cost-effectiveness of prophylactic clipping depending on the delayed bleeding (DB) risk score described by the Spanish Endoscopy Society Endoscopic Resection Group (GSEED-RE).

    Methods EMR of LNPCP were registered in the ongoing prospective multicenter database of the GSEED-RE from April 2013. Patients were classified according to the updated GSEED-RE DB risk score. Clip distances and DB risk reduction were obtained from our controlled trial (NCT02765022). Sensitivity analyses were performed varying this parameters: bleeding rate without clipping, clip interval, cost of one clip, cost of complete closure, cost of DB episode and incremental cost-effectiveness ratio (ICER) thresholds. As 24 combinations were considered, those analyzes can be used in any economic scenario.

    Results We registered 2263 EMR in 2130 patients until July 2017. DB rate in patients without clip prophylaxis was 4.6% in the total cohort (TC) and 12.9% in the high-risk group (HR). The average total cost was 2749.4€ per DB event (3349.3€ in the HR). Prophylactic clipping cost was estimated between 257 or 450€, depending on the clip interval. Universal clipping was no cost-effective, but selective clipping of HR patients was cost-effective in several scenarios.

    Tab. 1

    Figure 1

    Universal clipping(4.6% DB)

    Selective clipping(12.9% DB)

    58,7% RRR§

    89,6% RRR§

    58,7% RRR§

    89,6% RRR§

    ICER (€)

    325,659

    167,765

    2,239

    -54,065

    Cost-effectiveness

    No

    No

    Yes

    Yes

    Conclusions Clip closure of mucosal defects after EMR of LNPCP is cost-effective but also cost-saving when complete closure is achieved in patients with high risk of delayed bleeding.


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