Routine Prophylactic Endoscopic Clipping Is Not Efficacious in the Prevention of Delayed Post-Polypectomy Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Nauzer Forbes, Levi Frehlich, Matthew T James, Robert J Hilsden, Gilaad G Kaplan, Todd A Wilson, Diane L Lorenzetti, David J Tate, Michael J Bourke, Steven J Heitman, Nauzer Forbes, Levi Frehlich, Matthew T James, Robert J Hilsden, Gilaad G Kaplan, Todd A Wilson, Diane L Lorenzetti, David J Tate, Michael J Bourke, Steven J Heitman

Abstract

Background and aims: Colorectal cancer (CRC) can be prevented through colonoscopic polypectomy, but this exposes patients to risks, including delayed post-polypectomy bleeding (DPPB). Endoscopists increasingly use clips prophylactically with the aim of preventing DPPB. However, clips are costly, and data to support their efficacy in this context are inconsistent. We performed a systematic review and meta-analysis of randomized controlled trials to assess the efficacy of prophylactic clipping for preventing DPPB.

Methods: We searched electronic databases and other relevant sources for randomized controlled trials assessing the efficacy of prophylactic clipping versus no clipping for the prevention of DPPB. Pooled relative risks were determined using a fixed-effects model. Subgroup analyses were also performed.

Results: A total of 2305 citations were initially screened. Seven randomized controlled trials satisfied all criteria for inclusion. The quality of included studies was generally low to moderate. A total of 2851 patients underwent 5405 polypectomies. Delayed post-polypectomy bleeding occurred at an overall pooled rate of 2.5%. No overall benefit of clipping for preventing DPPB was observed, with a pooled relative risk of 0.86 (95% confidence interval [CI], 0.55 to 1.36). No significant patient or polyp factors predicting DPPB were found through subgroup analyses. No publication bias was identified.

Conclusions: Randomized trials to date do not demonstrate a protective effect of prophylactic clipping for the prevention of DPPB, and therefore, the practice of routine prophylactic clipping appears unjustified. Additional high quality randomized trials are required to identify higher-risk groups that may benefit from prophylactic clipping.

Keywords: Colonoscopy; Hemorrhage; Polyps.

Figures

Figure 1.
Figure 1.
Study flow diagram (22) detailing methodology for initial study identification, screening, eligibility and final inclusion for analysis.
Figure 2.
Figure 2.
Forest plot comparing clipping and nonclipping for prevention of delayed post-polypectomy bleeding.
Figure 3.
Figure 3.
Funnel plot assessing small study effects with regard to the protective effect of clipping (versus no clipping).

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Source: PubMed

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