The Role of Clips in Preventing Delayed Bleeding After Colorectal Polyp Resection: An Individual Patient Data Meta-Analysis
Year: 2021
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: 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.).
Authors: Ayla S. Turan, Heiko Pohl, Mio Matsumoto, Brian S. Lee, Masato Aizawa, Federico Desideri, Eduardo Albéniz, Gottumukkala S. Raju, Daniel Luba, Maximilien Barret, Suryakanth R. Gurudu, Francisco C. Ramirez, Wey-Ran Lin, Femke Atsma, Peter D. Siersema, Erwin J.M. van Geenen, Douglas K. Rex, Brian S. Lim, Karl K. Kwok, Kazutomo Togashi, Romain Coriat, Sarah B. Umar, Chun-Wei Chen, Jochim Terhaar sive Droste, Ruud Schrauwen, Gijs Kemper
Institutions: Radboud University Nijmegen, Radboud University Medical Center, Radboud Institute for Health Sciences, White River Junction VA Medical Center, NTT Medical Center Sapporo, University of California, Riverside, Fukushima Medical University, Fukushima Medical University Aizu Medical Center, Azienda Ospedaliera Sant'Andrea, Sapienza University of Rome, Universidad Pública de Navarra (UPNA), Complejo Hospitalario de Navarra, Navarrabiomed, The University of Texas MD Anderson Cancer Center, Université Paris Cité, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Mayo Clinic, Mayo Clinic in Arizona, Linkou Chang Gung Memorial Hospital, Kaiser Permanente Riverside Medical Center, Indiana University Indianapolis, Indiana University School of Medicine, Kaiser Permanente, Los Angeles Medical Center, Ziekenhuis Bernhoven
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,800
OpenAlex ID: W3163323965