Prophylactic clips to reduce delayed polypectomy bleeding after resection of large colorectal polyps: a systematic review and meta-analysis of randomized trials

Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China. Division of Gastroenterology & Hepatology, Loma Linda University Health, Loma Linda, CA 92354, USA. Electronic address:

Gastrointestinal endoscopy. 2020
BACKGROUND AND AIMS Prophylactic clips to prevent delayed polypectomy bleeding (DPB) after endoscopic resection of large colorectal polyps remains controversial. We performed a systematic review and meta-analysis to evaluate the efficacy of prophylactic clips for preventing DPB by synthesizing the results of randomized trials. METHODS PubMed, Cochrane Library, and EMBASE through October 2019 were searched to identify randomized controlled trials evaluating the efficacy of placing prophylactic clips to reduce DPB after resection of large (>10 mm) colorectal polyps. The primary outcome was DPB defined by GI bleeding after the conclusion of the colonoscopy. RESULTS Eight studies (N=3,415) met the study criteria, all with a low risk of bias. The overall pooled incidence of DPB was 3.9% (95% CI, 2.4%-5.4%) in patients receiving endoscopic resection of colorectal polyps >10 mm. Placing prophylactic clips reduced DPB in patients receiving prophylactic clips (RR, 0.61; 95% CI, 0.43-0.85; I(2)=37.8%) compared with no clips with a number-needed-to treat (NNT) of 52 (95% CI, 31-163). In stratified analyses, placing clips was associated with reduced risks of DPB in patients with polyp >20 mm (RR, 0.54; 95% CI, 0.35-0.84; I(2)=0.0%; NNT, 30), non-pedunculated morphology (RR, 0.54; 95% CI, 0.36-0.81; I(2)=0.0%; NNT, 39), and located proximal to the hepatic flexure (RR, 0.49; 95% CI, 0.31-0.78; I(2)=54.8%; NNT, 25) compared with no clips. CONCLUSIONS Prophylactic clips after endoscopic resection of colorectal polyps >10 mm demonstrated a modest reduction in the risk of DPB. Larger reductions were observed in patients with polyps >20 mm, nonpedunculated morphology, or located proximal to the hepatic flexure.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine