Prophylactic Endoscopic Clipping Does Not Prevent Delayed Postpolypectomy Bleeding in Routine Clinical Practice: A...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Clinical Effectiveness Research

Background:

• Delayed postpolypectomy bleeding (DPPB) is a common complication after colon polyp removal.
• Conflicting evidence exists regarding the effectiveness of prophylactic clipping in preventing DPPB.
• Real-world data on the effectiveness of prophylactic clipping are limited.

Purpose of the Study:

• To determine the effectiveness of prophylactic clipping in preventing DPPB in a large cohort of patients undergoing screening colonoscopies with polypectomy.

Main Methods:

• Manual review of records from 8,366 colonoscopies with polypectomy (2008-2014).
• Data collected included endoscopist, patient, and polyp characteristics.
• Primary outcome was DPPB within 30 days, adjudicated by committee.
• Multivariable logistic regression and propensity score-matched analyses were performed.

Main Results:

• 95 DPPB events occurred in 8,366 procedures.
• Prophylactic clipping was not associated with a reduced rate of DPPB (AOR 1.27; 95% CI 0.83-1.96).
• This finding held true in single-polyp cohorts and subgroup analyses, including propensity score-matched groups.

Conclusions:

• Prophylactic clipping is not associated with lower DPPB rates in this large cohort.
• Routine use of prophylactic clipping is not recommended for most patients undergoing polypectomy.
• Further studies are needed to evaluate cost-effectiveness and potential benefits in specific patient groups, such as those with large proximal lesions (≥20 mm).