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The Role of Clips in Preventing Delayed Bleeding After Colorectal Polyp Resection: An Individual Patient Data

Ayla S Turan1, Heiko Pohl2, Mio Matsumoto3

  • 1Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|May 15, 2021
PubMed
Summary

Prophylactic clipping effectively reduces delayed bleeding after removing large proximal colorectal polyps, particularly for patients on antithrombotics. This endoscopic technique offers significant benefits for specific polyp locations and patient profiles.

Keywords:
Colorectal PolypDelayed BleedingEndoscopic Mucosal ResectionNonpedunculatedPolypectomyProphylactic Clipping

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Oncology

Background:

  • Nonpedunculated colorectal polyps require endoscopic removal to prevent cancer progression.
  • Delayed bleeding is a common complication following polyp resection.
  • Prophylactic clipping of resection defects is a strategy to mitigate delayed bleeding.

Purpose of the Study:

  • To evaluate the efficacy of prophylactic clipping in reducing delayed bleeding after colorectal polyp resection.
  • To analyze the influence of polyp characteristics, defect closure extent, and antithrombotic use on bleeding rates.

Main Methods:

  • An individual patient data meta-analysis of studies on prophylactic clipping in nonpedunculated colorectal polyps.
  • Systematic literature search of major databases (PubMed, Embase, Web of Science, Cochrane) up to April 2020.
  • Multivariable mixed-effects models to assess the primary outcome (delayed bleeding ≤30 days) in various subgroups.

Main Results:

  • Data from 5380 patients and 8948 polyps were analyzed from 13 studies.
  • Prophylactic clipping significantly reduced delayed bleeding in proximal polyps ≥20 mm (OR, 0.62).
  • The benefit was more pronounced in patients using antithrombotics (OR, 0.59), especially anticoagulants/dual antiplatelet therapy (OR, 0.40).

Conclusions:

  • Prophylactic clipping is effective in reducing delayed bleeding for nonpedunculated, proximal colorectal polyps ≥20 mm.
  • The intervention is particularly beneficial for patients on antithrombotic therapy.
  • No significant benefit was observed for distal polyps ≥20 mm, suggesting patient and polyp-specific indications for prophylactic clipping.