Postpolypectomy prophylactic clip closure for the prevention of delayed postpolypectomy bleeding: A systematic review

Abstract

Delayed postpolypectomy bleeding (DPPB) is the most common complication of colonoscopic polypectomy. Prophylactic clipping after an uncomplicated polypectomy is increasingly used, but it is unclear if this results in the prevention of DPPB. This study aimed to review prophylactic clip use and its effect on the rates of DPPB. MEDLINE, Embase, and the Cochran Library were systematically searched for studies (1995-March 2017) that used prophylactic hemoclips and assessed DPPB as an outcome. Of 1402 articles identified, nine papers were eligible for inclusion, evaluating 4311 patients and 7783 polyps; 118 patients experienced a DPPB, and 49 of these patients received prophylactic clips. There was no significant difference in DPPB rates in patients who received prophylactic clipping compared to those who did not (odd ratio: 0.8; 95% confidence interval: 0.36-1.77; P = 0.56). There was also no significant difference in the DPPB of polyps <20 mm compared with polyps ≥20 mm. Clip application for prophylactic management of an uncomplicated polypectomy has not been demonstrated to reduce the risk of DPPB, casting doubt on the use of this costly practice.

Keywords: bleeding; clip; polypectomy; prophylactic; systematic review.

Figure 1

Trial search flow chart.

Figure 2

Forest plot showing the comparison of delayed postpolypectomy bleeding of prophylactically clipped and nonclipped polypectomy defects in all studies.

Figure 3

The Funnel plot horizontal axis represents the log odds ratio from the individual studies. The vertical axis represents the standard error of the log odds ratios. Studies with larger standard errors have a wider confidence interval caused by smaller sample size. The graphed vertical line represents the pooled odds ratio. The points represent the observed distribution of the published studies.