Prophylactic clipping and post-polypectomy bleeding: a meta-analysis and systematic review

Christine Boumitri, Fazia A Mir, Imran Ashraf, Michelle L Matteson-Kome, Douglas L Nguyen, Srinivas R Puli, Matthew L Bechtold, Christine Boumitri, Fazia A Mir, Imran Ashraf, Michelle L Matteson-Kome, Douglas L Nguyen, Srinivas R Puli, Matthew L Bechtold

Abstract

Background: Bleeding after polypectomy is a common issue associated with colonoscopy. To help prevent post-polypectomy bleeding, many endoscopists place clips at the site. However, this practice remains controversial. Therefore, we performed a meta-analysis of the efficacy of clip placement in the prevention of post-polypectomy bleeding.

Methods: Multiple databases, including Embase, Scopus, MEDLINE/PubMed, CINAHL, Cochrane databases, and recent abstracts from major American meetings were searched in April 2016. Using the DerSimonian and Laird (random effects) model with odds ratio (OR), a meta-analysis was performed of post-polypectomy bleeding with prophylactic clip versus no prophylactic clip.

Results: Five hundred and thirty potential articles and abstracts were discovered. Thirty-five articles were reviewed, with 12 studies satisfying the inclusion criteria. No statistically significant difference in prophylactic clipping versus no prophylactic clipping for post-polypectomy bleeding in all polyps was found when all studies (OR 1.49; 95% CI: 0.56-4.00; P=0.42), only peer-reviewed studies where abstracts were excluded (OR 0.84; 95% CI: 0.42-1.69; P=0.63), and only randomized controlled trials (OR 1.24; 95% CI: 0.69-2.24; P=0.47) were analyzed.

Conclusions: The use of prophylactic clipping for all polypectomies does not seem to prevent post-polypectomy bleeding and should not be a routine practice. However, for large polyps (>2 cm), prophylactic clipping may or may not be beneficial in preventing post-polypectomy bleeding. Further studies are required to fully evaluate this subgroup.

Keywords: Prophylactic; bleeding; clip; polypectomy.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Details of article search and identification
Figure 2
Figure 2
Forest plot showing the comparison between prophylactic clipping and no prophylactic clipping for polypectomies in all studies
Figure 3
Figure 3
Forest plot showing the comparison between prophylactic clipping and no prophylactic clipping for polypectomies in only peer-reviewed studies (no abstracts)
Figure 4
Figure 4
Forest plot showing the comparison between prophylactic clipping and no prophylactic clipping for polypectomies in only randomized controlled trials

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