Endoscopic clip placement for the prevention of perforation after colonic endoscopic mucosal resection

Endoscopically placed clips have gained a prominent role in the management of bleeding or perforation during endoscopic mucosal resection of large colonic polyps. Clips may be used to treat intraprocedural complications, but may also be placed prophylactically when patients are at an increased risk for post-procedural bleeding or delayed perforation. Polyp size, location, resection technique, and appearance of the resection defect can all influence the decision on whether to place prophylactic clips. Not all post-polypectomy defects require clip placement. The downsides of clip placement include increased cost and the possibility of “clip artifact” mimicking residual polyp on surveillance examinations. When clipping, attention to proper technique can ensure secure closure of the defect and efficient placement of additional clips. Over-the-scope clips and endoscopic suturing are other strategies which can be used for treatment of bleeding or perforation, though each requires attachment to the scope and training for use.