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Comparative Effectiveness of a Prophylactic Application for the Prevention of Postpolypectomy Bleeding in
Jae Hyun Kim1, Jung Won Lee2, Hyun Jung Kim3
1Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Background/Aims:
Postpolypectomy bleeding (PPB) is a major complication of pedunculated colonic polyps. Various prophylactic interventions, including clips, endoloops, and epinephrine injections, have been proposed to prevent PPB; however, their comparative effectiveness remains unclear. This study aimed to evaluate the efficacy of these interventions through a network meta-analysis.
Methods:
We searched the MEDLINE, EMBASE, and Cochrane CENTRAL databases for randomized controlled trials that compared the effectiveness of clips, endoloops, and epinephrine injection in the prevention of PPB in pedunculated polyps with a head diameter ≥10 mm. Primary outcomes included immediate and delayed PPB. Data synthesis was performed with the netmeta package in R, which integrates direct and indirect evidence and yields odds ratios (ORs) and 95% confidence intervals (CIs).
Results:
Of 601 identified studies, 11 trials involving 2,096 patients were included. In the network meta-analysis, endoloops (OR, 0.23; 95% CI, 0.08 to 0.63), clips (OR, 0.25; 95% CI, 0.14 to 0.48), and epinephrine injection (OR, 0.33; 95% CI, 0.11 to 0.96) were significantly more effective than no treatment in the prevention of immediate bleeding. Combinations of endoloops or clips with epinephrine injection also demonstrated satisfactory efficacy. For delayed bleeding, no significant differences were observed among the interventions or between each intervention and no treatment, which may be due to the small number of events across studies. According to surface under the cumulative ranking curve rankings, endoloops plus epinephrine injection was the most effective method for preventing immediate PPB, followed by endoloops and clips alone.
Conclusions:
This network meta-analysis supports the use of endoloops with epinephrine as the most effective strategy for preventing immediate bleeding after resection of pedunculated colonic polyps, while current measures remain insufficient for delayed bleeding.
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