TY - JOUR
T1 - The Role of Clips in Preventing Delayed Bleeding After Colorectal Polyp Resection
T2 - An Individual Patient Data Meta-Analysis
AU - Prophylactic Clipping Collaborative Group
AU - Turan, Ayla S.
AU - Pohl, Heiko
AU - Matsumoto, Mio
AU - Lee, Brian S.
AU - Aizawa, Masato
AU - Desideri, Federico
AU - Albéniz, Eduardo
AU - Raju, Gottumukkala S.
AU - Luba, Daniel
AU - Barret, Maximilien
AU - Gurudu, Suryakanth R.
AU - Ramirez, Francisco C.
AU - Lin, Wey Ran
AU - Atsma, Femke
AU - Siersema, Peter D.
AU - van Geenen, Erwin J.M.
AU - Rex, Douglas K.
AU - Lim, Brian S.
AU - Kwok, Karl K.
AU - Togashi, Kazutomo
AU - Coriat, Romain
AU - Umar, Sarah B.
AU - Chen, Chun Wei
AU - Terhaar sive Droste, Jochim
AU - Schrauwen, Ruud
AU - Kemper, Gijs
N1 - Funding Information:
Conflicts of interest These authors disclose the following: Ayla S. Turan’s PhD position is financed by a research grant from the Dutch Digestive Foundation (MLDS). Peter D. Siersema receives research support from Pentax, Micro-Tech, Norgine, and The eNose company; and is on the advisory board of Boston Scientific. Erwin J.M. van Geenen currently receives research grants from Olympus, MTW-Endoskopie, Boston Scientific, and Mylan. The other authors disclose no conflicts.
Publisher Copyright:
© 2022 AGA Institute
PY - 2022/2
Y1 - 2022/2
N2 - 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.)
AB - 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.)
KW - Colorectal Polyp
KW - Delayed Bleeding
KW - Endoscopic Mucosal Resection
KW - Nonpedunculated
KW - Polypectomy
KW - Prophylactic Clipping
UR - http://www.scopus.com/inward/record.url?scp=85117149681&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85117149681&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2021.05.012
DO - 10.1016/j.cgh.2021.05.012
M3 - Article
C2 - 33991691
AN - SCOPUS:85117149681
SN - 1542-3565
VL - 20
SP - 362-371.e23
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 2
ER -