The role of clips in preventing delayed bleeding after colorectal polyp resection: an individual patient data meta-analysis

Department of Gastroenterology and Hepatology, Radboudumc, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. Electronic address: aylaturan@radboudumc.nl. Section of Gastroenterology and Hepatology, VA White River Junction, White River Junction, Vermont, USA. Department of Gastroenterology, Sapporo Medical Center NTT EC, Japan. Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, California, USA. Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu, Japan. Digestive and Liver Disease Department, Endoscopy Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy.; Gastroenterology Department, San Maurizio Hospital, Bolzano, Italy. Department of Gastroenterology, Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center. UPNA. IdiSNA, Pamplona, Spain. University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Monterey Bay Gastroenterology Consultants, Monterey, Ca 93940, USA. Department of Gastroenterology, Cochin Hospital, AP-HP, Université de Paris, France. Department of Gastroenterology, Mayo Clinic, Scottsdale, Arizona, USA. Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan. Radboud university medical center, Radboud Institute for Health Sciences, Department of IQ Healthcare, Nijmegen, The Netherlands. Department of Gastroenterology and Hepatology, Radboudumc, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA. Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, California, USA; Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, California, USA. Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA. Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands. Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands.

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2021
Abstract
BACKGROUND & AIMS Non-pedunculated 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 non-pedunculated 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 5,380 patients with 8,948 resected polyps were included from three RCT's, two prospective and eight retrospective studies. Prophylactic clipping reduced delayed bleeding in proximal polyps ≥20 mm (OR 0.62; 95% CI 0.44 - 0.88; Number Needed to Treat [NNT] = 32), especially with antithrombotics (OR 0.59; 95% CI 0.35 - 0.99; NNT = 23; subgroup of anticoagulants/double platelet inhibitors N=226; OR 0.40; 95% CI 0.16 - 1.01; NNT = 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 non-pedunculated, 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).
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine