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Meta-Analysis
. 2019 May 14;25(18):2251-2263.
doi: 10.3748/wjg.v25.i18.2251.

Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis

Fares Ayoub  1 , Donevan R Westerveld  1 , Justin J Forde  1 , Christopher E Forsmark  2 , Peter V Draganov  2 , Dennis Yang  3
Affiliations
Meta-Analysis

Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis

Fares Ayoub et al. World J Gastroenterol. .

Abstract

Background: The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes.

Aim: To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection (EMR) of colorectal lesions ≥ 20 mm.

Methods: We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I 2 were used to test for heterogeneity. Pooling was conducted using a random-effects model.

Results: Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB (1.4%) when compared to no clipping (5.2%) (pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm. There was no significant heterogeneity among the studies (I 2 = 0%, P = 0.67).

Conlusion: Prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.

Keywords: Clipping; Endoscopic mucosal resection; Endoscopic resection; Meta-analysis.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that no conflict of interest exists. There are no financial or other competing interests for principal investigators, patients included or any member of the trial.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forrest plot of the included studies evaluating the rate of delayed polypectomy bleeding after colorectal endoscopic mucosal resection of lesions ≥ 20 mm (A) and funnel plot of studies evaluating the rate of delayed polypectomy bleeding after colorectal endoscopic mucosal resection of lesions ≥ 20 mm (B).
Figure 3
Figure 3
Forrest plots on the effect of prophylactic clipping on delayed polypectomy bleeding following colorectal endoscopic resection stratified by study type (A) and funnel plot of the included studies comparing the rate of delayed polypectomy bleeding between clipping vs no clipping (B).
Figure 4
Figure 4
Forrest plot of the included studies evaluating the rate of delayed polypectomy bleeding for lesions ≥ 20 mm.
See this image and copyright information in PMC

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