Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Feb;20(2):362-371.e23.
doi: 10.1016/j.cgh.2021.05.012. Epub 2021 May 12.

The Role of Clips in Preventing Delayed Bleeding After Colorectal Polyp Resection: An Individual Patient Data Meta-Analysis

Ayla S Turan  1 , Heiko Pohl  2 , Mio Matsumoto  3 , Brian S Lee  4 , Masato Aizawa  5 , Federico Desideri  6 , Eduardo Albéniz  7 , Gottumukkala S Raju  8 , Daniel Luba  9 , Maximilien Barret  10 , Suryakanth R Gurudu  11 , Francisco C Ramirez  11 , Wey-Ran Lin  12 , Femke Atsma  13 , Peter D Siersema  14 , Erwin J M van Geenen  14 ; Prophylactic Clipping Collaborative Group
Collaborators, Affiliations
Free article
Meta-Analysis

The Role of Clips in Preventing Delayed Bleeding After Colorectal Polyp Resection: An Individual Patient Data Meta-Analysis

Ayla S Turan et al. Clin Gastroenterol Hepatol. 2022 Feb.
Free article

Abstract

Background & aims: Nonpedunculated colorectal polyps are normally endoscopically removed to prevent neoplastic progression. Delayed bleeding is the most common major adverse event. Clipping the resection defect has been suggested to reduce delayed bleedings. Our aim was to determine if prophylactic clipping reduces delayed bleedings and to analyze the contribution of polyp characteristics, extent of defect closure, and antithrombotic use.

Methods: An individual patient data meta-analysis was performed. Studies on prophylactic clipping in nonpedunculated colorectal polyps were selected from PubMed, Embase, Web of Science, and Cochrane database (last selection, April 2020). Authors were invited to share original study data. The primary outcome was delayed bleeding ≤30 days. Multivariable mixed models were used to determine the efficacy of prophylactic clipping in various subgroups adjusted for confounders.

Results: Data of 5380 patients with 8948 resected polyps were included from 3 randomized controlled trials, 2 prospective, and 8 retrospective studies. Prophylactic clipping reduced delayed bleeding in proximal polyps ≥20 mm (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.44-0.88; number needed to treat = 32), especially with antithrombotics (OR, 0.59; 95% CI, 0.35-0.99; number needed to treat = 23; subgroup of anticoagulants/double platelet inhibitors: n = 226; OR, 0.40; 95% CI, 0.16-1.01; number needed to treat = 12). Prophylactic clipping did not benefit distal polyps ≥20 mm with antithrombotics (OR, 1.41; 95% CI, 0.79-2.52).

Conclusions: Prophylactic clipping reduces delayed bleeding after resection of nonpedunculated, proximal colorectal polyps ≥20 mm, especially in patients using antithrombotics. No benefit was found for distal polyps. Based on this study, patients can be identified who may benefit from prophylactic clipping. (PROSPERO registration number CRD42020104317.).

Keywords: Colorectal Polyp; Delayed Bleeding; Endoscopic Mucosal Resection; Nonpedunculated; Polypectomy; Prophylactic Clipping.

PubMed Disclaimer

Publication types

MeSH terms