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After endoscopic resection of large colorectal polyps, closing polypectomy defects with clips is thought to decrease severe bleeding risk, but supportive evidence is sparse.
In an industry-funded, randomized, controlled trial (RCT), over 900 patients who underwent endoscopic mucosal resection (EMR) of large (≥20 mm) polyps were assigned to clip closure versus none, and to one of two electrocautery settings. The primary outcome was postprocedure bleeding requiring hospitalization, blood transfusion, or invasive intervention within 30 days.
Results were as follows:
Bleeding was significantly less frequent in the clip group compared with controls (3.5% vs 7.1%); the number of patients needed to treat (NNT) to prevent one bleeding episode was 28.
T…