Postpolypectomy prophylactic clip closure for the prevention of delayed postpolypectomy bleeding: A systematic review

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Delayed postpolypectomy bleeding (DPPB) is a common complication following colonoscopic polypectomy.
• Prophylactic clipping is increasingly employed, but its efficacy in preventing DPPB remains uncertain.

Purpose of the Study:

• To systematically review the use of prophylactic hemoclips after uncomplicated colonoscopic polypectomy.
• To evaluate the impact of prophylactic clipping on the incidence of DPPB.

Main Methods:

• A systematic literature search was conducted across MEDLINE, Embase, and the Cochrane Library (1995-March 2017).
• Included studies assessed prophylactic hemoclip use and DPPB outcomes.
• Data from 9 eligible studies involving 4311 patients and 7783 polyps were analyzed.

Main Results:

• A total of 118 cases of DPPB were reported; 49 occurred in patients who received prophylactic clips.
• No statistically significant difference in DPPB rates was observed between patients who received prophylactic clipping and those who did not (OR: 0.8; 95% CI: 0.36-1.77; P = 0.56).
• DPPB rates did not differ significantly between polyps <20 mm and polyps ≥20 mm.

Conclusions:

• Prophylactic clip application following uncomplicated colonoscopic polypectomy has not been proven to reduce the risk of DPPB.
• The routine use of prophylactic clipping for DPPB prevention warrants re-evaluation due to lack of demonstrated benefit and associated costs.