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Related Experiment Video

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Practice patterns and predictors of prophylactic endoscopic clip usage during polypectomy.

Nauzer Forbes1,2,3, Robert J Hilsden1,2,3, Gilaad G Kaplan1,2

  • 1Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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Summary

Prophylactic endoscopic clips are often used after polyp removal, but evidence supporting their benefit is lacking. This study found clip use increased over time despite unclear benefits, suggesting a need for better practice guidelines.

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Area of Science:

  • Gastroenterology
  • Endoscopic Procedures
  • Medical Device Utilization

Background:

  • Prophylactic endoscopic clips are frequently used post-polypectomy to prevent delayed bleeding.
  • The clinical evidence supporting routine prophylactic clip use remains inconclusive.
  • Variability in practice and temporal trends warrant investigation.

Purpose of the Study:

  • To identify factors influencing prophylactic clip use during polypectomy.
  • To examine variations in clipping practices among endoscopists.
  • To analyze trends in prophylactic clip application over time.

Main Methods:

  • Retrospective cohort study of colonoscopies with polypectomy (2008-2014).
  • Analysis of 8,366 colonoscopies and 19,129 polypectomies.
  • Hierarchical regression models to identify predictors of prophylactic clipping.

Main Results:

  • Larger polyps (≥20mm) and right-sided location were associated with increased clip use.
  • Surgeons used clips less frequently than gastroenterologists.
  • Prophylactic clip use rose from 1.9% to 9.3% between 2008 and 2014, with significant inter-endoscopist variability.

Conclusions:

  • Prophylactic clip use correlates with known bleeding risk factors but has increased without clear evidence of benefit.
  • Significant inter-endoscopist variability and rising usage highlight a need for standardized guidelines.
  • Optimizing resource allocation by limiting unnecessary prophylactic clipping is recommended.