{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T23:40:03Z","timestamp":1792453203007,"version":"4.5.0"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clinically significant post-endoscopic mucosal resection (EMR) bleeding (CSPEB) is the most common adverse event after EMR of large nonpedunculated colorectal polyps (LNPCPs). Randomized trials of prophylactic through-the-scope (TTS) clip closure have produced conflicting results, and it remains unclear whether the effect is uniform across right-colon subsites and whether complete apposition is required. We examined real-world outcomes of a universal right-colon clipping policy, with attention given to subsite heterogeneity and closure completeness.<\/jats:p>\n                  <jats:p>Consecutive patients who underwent EMR of right-sided LNPCPs \u226520 mm (January 2020\u2013October 2025) with prophylactic TTS clip closure were identified from the prospectively maintained ACE (Australian Colonic Endoscopic resection) registry, and matched 1:1 by propensity score to a no-clip comparator from the same registry (pre-2020). The primary end point was CSPEB within 14 days; subsite heterogeneity and closure completeness were exploratory analyses.<\/jats:p>\n                  <jats:p>Propensity score matching yielded 235 matched pairs (n = 470), who were well balanced on all covariates. CSPEB occurred in 8\/235 clipped (3.4%) versus 26\/235 unclipped patients (11.1%; relative risk 0.31, 95%CI 0.14\u20130.66; number needed to treat 13; P = 0.002). Exploratory subsite analyses suggested benefit concentrated at the hepatic flexure (0% vs. 17.2%; P = 0.02) and ascending colon (2.0% vs. 10.1%; P = 0.03), with a nonsignificant difference at the cecum (8.2% vs. 13.7%; P = 0.43). Within the clipped cohort, CSPEB rates were similar with complete (5\/143; 3.5%) and partial (3\/92; 3.3%) closure (P &gt; 0.99).<\/jats:p>\n                  <jats:p>In this single-center analysis, TTS clip closure was associated with lower CSPEB after right-colon EMR, especially at the hepatic flexure and ascending colon; partial apposition appeared as effective as complete closure. These hypothesis-generating observations warrant prospective evaluation.<\/jats:p>","DOI":"10.1055\/a-2944-4098","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T22:50:36Z","timestamp":1787611836000},"source":"Crossref","is-referenced-by-count":0,"title":["Prophylactic clip closure after right-colon endoscopic mucosal resection in a matched cohort of 470 patients exhibits subsite heterogeneity"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2347-2903","authenticated-orcid":false,"given":"Mayan","family":"Eitan","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]},{"name":"Tel Aviv University, Israel","place":["Tel Aviv"],"department":["Gray Faculty of Medical and Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3471-8304","authenticated-orcid":false,"given":"Sunil","family":"Gupta","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]},{"name":"The University of Sydney Westmead Clinical School, New South Wales, Australia","place":["Sydney"],"department":["Medicine"]},{"name":"St Michael's Hospital, Canada","place":["Toronto"],"department":["Division of Gastroenterology, University of Toronto"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1815-5532","authenticated-orcid":false,"given":"Jun Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]},{"name":"The University of Sydney Westmead Clinical School, New South Wales, Australia","place":["Sydney"],"department":["Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7389-408X","authenticated-orcid":false,"given":"Yong Sul","family":"Kim","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlene","family":"Deane","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert Jeroen","family":"De Groof","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]},{"name":"Amsterdam UMC Locatie De Boelelaan, Netherlands","place":["Amsterdam"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Williams","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2032-4049","authenticated-orcid":false,"given":"Brian","family":"Lam","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas G.","family":"Burgess","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]},{"name":"The University of Sydney Westmead Clinical School, New South Wales, Australia","place":["Sydney"],"department":["Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Bourke","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Westmead"],"department":["Gastroenterology and Hepatology"]},{"name":"The University of Sydney Westmead Clinical School, New South Wales, Australia","place":["Sydney"],"department":["Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1136\/gutjnl-2013-305516","article-title":"Long-term adenoma recurrence following 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bleeding of large, proximal polyps: meta-analysis of randomized trials","volume":"159","author":"M Spadaccini","year":"2020","journal-title":"Gastroenterology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1093\/jcag\/gwy033","article-title":"Routine prophylactic endoscopic clipping is not efficacious in the prevention of delayed post-polypectomy bleeding: a systematic review and meta-analysis of randomized controlled trials","volume":"2","author":"N Forbes","year":"2019","journal-title":"J Can Assoc Gastroenterol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.gie.2022.05.020","article-title":"Clip closure to prevent adverse events after EMR of proximal large nonpedunculated colorectal polyps: meta-analysis of individual patient data from randomized controlled trials","volume":"96","author":"N Forbes","year":"2022","journal-title":"Gastrointest 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