The Use of Clips to Prevent Post-Polypectomy Bleeding: A Clinical Review

Matthew A O'Mara ¹, Peter G Emanuel ¹, Aaron Tabibzadeh ²

⁰Division of Gastroenterology, NYU Langone Health, New York, NY, USA.

Journal of Clinical Gastroenterology +

|

July 15, 2024

View abstract on PubMed

Summary

Prophylactic clips effectively reduce postpolypectomy bleeding (PPB) for large, non-pedunculated polyps, particularly in the proximal colon and for patients on antithrombotics. They also control immediate bleeding from large pedunculated polyps.

Area Of Science

Gastroenterology
Endoscopic Surgery

Background

Colonoscopy is crucial for detecting and removing precancerous lesions.
Postpolypectomy bleeding (PPB) is a potential complication following colonoscopic polypectomy.
The efficacy of prophylactic clip application for preventing PPB is not definitively established.

Purpose Of The Study

To review the current literature on the effectiveness of prophylactic clips in minimizing postpolypectomy bleeding.
To offer expert guidance on the appropriate use of prophylactic clips in clinical practice.

Main Methods

A comprehensive literature search was performed using PubMed and Embase.
671 publications were screened, with 67 relevant studies selected for analysis.
Data on clip use, polyp features, and adverse events were extracted and synthesized.

Main Results

Prophylactic clipping is most advantageous for non-pedunculated polyps ≥20 mm, especially in the proximal colon.
The benefit of clipping smaller or distal polyps is less certain.
Patients on antithrombotic medications, particularly anticoagulants, may benefit from prophylactic clipping due to increased bleeding risk.

Conclusions

Prophylactic clips are beneficial for preventing delayed bleeding after removing large non-pedunculated polyps, particularly in the proximal colon and in patients on antithrombotics.
For large pedunculated polyps, prophylactic clipping is effective in managing immediate bleeding.