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. 2016 Oct-Dec;29(4):502-508.
doi: 10.20524/aog.2016.0075. Epub 2016 Jul 28.

Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review

Christine Boumitri  1 , Fazia A Mir  1 , Imran Ashraf  1 , Michelle L Matteson-Kome  1 , Douglas L Nguyen  2 , Srinivas R Puli  3 , Matthew L Bechtold  1
Affiliations

Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review

Christine Boumitri et al. Ann Gastroenterol. 2016 Oct-Dec.

Abstract

Background: Bleeding after polypectomy is a common issue associated with colonoscopy. To help prevent post-polypectomy bleeding, many endoscopists place clips at the site. However, this practice remains controversial. Therefore, we performed a meta-analysis of the efficacy of clip placement in the prevention of post-polypectomy bleeding.

Methods: Multiple databases, including Embase, Scopus, MEDLINE/PubMed, CINAHL, Cochrane databases, and recent abstracts from major American meetings were searched in April 2016. Using the DerSimonian and Laird (random effects) model with odds ratio (OR), a meta-analysis was performed of post-polypectomy bleeding with prophylactic clip versus no prophylactic clip.

Results: Five hundred and thirty potential articles and abstracts were discovered. Thirty-five articles were reviewed, with 12 studies satisfying the inclusion criteria. No statistically significant difference in prophylactic clipping versus no prophylactic clipping for post-polypectomy bleeding in all polyps was found when all studies (OR 1.49; 95% CI: 0.56-4.00; P=0.42), only peer-reviewed studies where abstracts were excluded (OR 0.84; 95% CI: 0.42-1.69; P=0.63), and only randomized controlled trials (OR 1.24; 95% CI: 0.69-2.24; P=0.47) were analyzed.

Conclusions: The use of prophylactic clipping for all polypectomies does not seem to prevent post-polypectomy bleeding and should not be a routine practice. However, for large polyps (>2 cm), prophylactic clipping may or may not be beneficial in preventing post-polypectomy bleeding. Further studies are required to fully evaluate this subgroup.

Keywords: Prophylactic; bleeding; clip; polypectomy.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Details of article search and identification
Figure 2
Figure 2
Forest plot showing the comparison between prophylactic clipping and no prophylactic clipping for polypectomies in all studies
Figure 3
Figure 3
Forest plot showing the comparison between prophylactic clipping and no prophylactic clipping for polypectomies in only peer-reviewed studies (no abstracts)
Figure 4
Figure 4
Forest plot showing the comparison between prophylactic clipping and no prophylactic clipping for polypectomies in only randomized controlled trials
See this image and copyright information in PMC

References

    1. NIH. SEER Stat Fact Sheets: Colon and Rectum Cancer. 2016. Available at: http://seer.cancer.gov/statfacts/html/colorect.html .
    1. Rosen L, Bub DS, Reed JF, 3rd, Nastasee SA. Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum. 1993;36:1126–1131. - PubMed
    1. Dobrowolski S, Dobosz M, Babicki A, Głowacki J, Nałecz A. Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy. Gastrointest Endosc. 2006;63:1004–1009. - PubMed
    1. Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH. Risk factors for severe delayed postpolypectomy bleeding. Endoscopy. 2008;40:115–119. - PubMed
    1. Singaram C, Torbey CF, Jacoby RF. Delayed postpolypectomy bleeding. Am J Gastroenterol. 1995;90:146–147. - PubMed

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