Skip to main content

Advertisement

SpringerLink
Log in

Prevention of delayed post-polypectomy bleeding by prophylactic clipping after endoscopic colorectal polypectomy: a meta-analysis

  • Research
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This meta-analysis aims to investigate the role of prophylactic clipping after endoscopic colorectal polypectomy or endoscopic mucosal resection (EMR) in prevention of delayed bleeding (DB) following polypectomy.

Methods

We searched the PubMed, Embase, and Cochrane Library databases for randomized controlled trials comparing the effect of prophylactic clipping versus no clipping on DB since inception to 22nd April 2022. We then performed a meta-analysis using a random-effects model.

Results

We included 8 studies with 5648 patients and 10,436 lesions. Prophylactic clipping did not reduce the overall risk of DB compared with no clipping (1.54% vs 2.05%; Log RR, −0.29; 95% confidence interval [CI], −0.59, 0.01; P = 0.06). In subgroup analyses, clipping significantly reduced DB rate in polyps ≥ 2 cm (Log RR, −0.63; 95% CI, −1.08, −0.18; P = 0.01), in non-pedunculated polyps (Log RR, −0.63; 95% CI, −1.01, −0.24; P = 0.00), and in large (≥ 2 cm) proximal polyps (Log RR, −0.81; 95% CI, −1.56, 0.05; P = 0.04), but not in polyps < 2 cm (Log RR, 0.01; 95% CI, −.40, 0.42; P = 0.95).

Conclusion

Prophylactic clipping does not prevent post-polypectomy bleeding after all EMR and should not be performed as a routine practice. Although prophylactic clipping may reduce DB rate following resection of large proximal polyps and non-pedunculated polyps, more high-quality studies are needed to determine the effects of factors such as polyp location, polyp morphology, antithrombotic drug use and complete or partial closure on the effectiveness of prophylactic clipping.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Zauber AG, Winawer SJ, O’Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF, Stewart ET, Waye JD (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366:687–696. https://doi.org/10.1056/NEJMoa1100370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Corley DA, Levin TR, Doubeni CA (2014) Adenoma detection rate and risk of colorectal cancer and death. N Engl J Med 370:2539–2541. https://doi.org/10.1056/NEJMc1405329

    Article  Google Scholar 

  3. Nishihara R, Wu K, Lochhead P, Morikawa T, Liao X, Qian ZR, Inamura K, Kim SA, Kuchiba A, Yamauchi M, Imamura Y, Willett WC, Rosner BA, Fuchs CS, Giovannucci E, Ogino S, Chan AT (2013) Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 369:1095–1105. https://doi.org/10.1056/NEJMoa1301969

    Article  CAS  PubMed  Google Scholar 

  4. Matsumoto M, Kato M, Oba K, Abiko S, Tsuda M, Miyamoto S, Mizushima T, Ono M, Omori S, Takahashi M, Ono S, Mabe K, Nakagawa M, Nakagawa S, Kudo T, Shimizu Y, Sakamoto N (2016) Multicenter randomized controlled study to assess the effect of prophylactic clipping on post-polypectomy delayed bleeding. Dig Endosc 28:570–576. https://doi.org/10.1111/den.12661

    Article  PubMed  Google Scholar 

  5. Parikh ND, Zanocco K, Keswani RN, Gawron AJ (2013) A cost-efficacy decision analysis of prophylactic clip placement after endoscopic removal of large polyps. Clin Gastroenterol Hepatol 11:1319–1324. https://doi.org/10.1016/j.cgh.2012.12.044

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zhang QS, Han B, Xu JH, Gao P, Shen YC (2015) Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events. Gastrointest Endosc 82:904–909. https://doi.org/10.1016/j.gie.2015.04.005

    Article  PubMed  Google Scholar 

  7. Albéniz E, Álvarez MA, Espinós JC, Nogales O, Guarner C, Alonso P, Rodríguez-Téllez M, Herreros de Tejada A, Santiago J, Bustamante-Balén M, Rodríguez Sánchez J, Ramos-Zabala F, Valdivielso E, Martínez-Alcalá F, Fraile M, Elosua A, Guerra Veloz MF, Ibáñez Beroiz B, Capdevila F, Enguita-Germán M (2019) Clip closure after resection of large colorectal lesions with substantial risk of bleeding. Gastroenterology 157:1213–1221.e4. https://doi.org/10.1053/j.gastro.2019.07.037

    Article  PubMed  Google Scholar 

  8. Pohl H, Grimm IS, Moyer MT, Hasan MK, Pleskow D, Elmunzer BJ, Khashab MA, Sanaei O, Al-Kawas FH, Gordon SR, Mathew A, Levenick JM, Aslanian HR, Antaki F, von Renteln D, Crockett SD, Rastogi A, Gill JA, Law RJ, Elias PA, Pellise M, Wallace MB, Mackenzie TA, Rex DK (2019) Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 157:977–984.e3. https://doi.org/10.1053/j.gastro.2019.03.019

    Article  PubMed  Google Scholar 

  9. Inoue T, Ishihara R, Nishida T, Akasaka T, Hayashi Y, Nakamatsu D, Ogiyama H, Yamaguchi S, Yamamoto K, Mukai A, Kinoshita K, Yakushijin T, Iijima H, Takehara T (2021) Prophylactic clipping not effective in preventing post-polypectomy bleeding for < 20-mm colon polyps: a multicenter, open-label, randomized controlled trial. J Gastroenterol Hepatol 36:383–390. https://doi.org/10.1111/jgh.15134

    Article  PubMed  Google Scholar 

  10. Feagins LA, Smith AD, Kim D, Halai A, Duttala S, Chebaa B, Lunsford T, Vizuete J, Mara M, Mascarenhas R, Meghani R, Kundrotas L, Dunbar KB, Cipher DJ, Harford WV, Spechler SJ (2019) Efficacy of prophylactic hemoclips in prevention of delayed post-polypectomy bleeding in patients with large colonic polyps. Gastroenterology 157:967–976.e961. https://doi.org/10.1053/j.gastro.2019.05.003

    Article  PubMed  Google Scholar 

  11. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: elaboration and explanation. BMJ 350:g7647. https://doi.org/10.1136/bmj.g7647

    Article  PubMed  Google Scholar 

  12. Shioji K, Suzuki Y, Kobayashi M, Nakamura A, Azumaya M, Takeuchi M, Baba Y, Honma T, Narisawa R (2003) Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 57:691–694. https://doi.org/10.1067/mge.2003.193

    Article  PubMed  Google Scholar 

  13. Dokoshi T, Fujiya M, Tanaka K, Sakatani A, Inaba Y, Ueno N, Kashima S, Goto T, Sasajima J, Tominaga M, Ito T, Moriichi K, Tanabe H, Ikuta K, Ohtake T, Kohgo Y (2015) A randomized study on the effectiveness of prophylactic clipping during endoscopic resection of colon polyps for the prevention of delayed bleeding. Biomed Res Int 2015:490272. https://doi.org/10.1155/2015/490272

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tominaga N, Tanaka Y, Higuchi T, Yamaguchi D, Watanabe A, Ogata S, Kajiwara T (2014) The effect of hemostasis clipping post endoscopic mucosal resection of colorectal polyps. Gastroenterol Endosc 56:15–20. https://doi.org/10.11280/gee.56.15

    Article  Google Scholar 

  15. Jaruvongvanich V, Prasitlumkum N, Assavapongpaiboon B, Suchartlikitwong S, Sanguankeo A, Upala S (2017) Risk factors for delayed colonic post-polypectomy bleeding: a systematic review and meta-analysis. Int J Colorectal Dis 32:1399–1406. https://doi.org/10.1007/s00384-017-2870-0

    Article  PubMed  Google Scholar 

  16. Liu C, Wu R, Sun X, Tao C, Liu Z (2019) Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: polyp size and operative modality. JGH Open 3:61–64. https://doi.org/10.1002/jgh3.12106

    Article  PubMed  Google Scholar 

  17. Park SK, Seo JY, Lee MG, Yang HJ, Jung YS, Choi KY, Kim H, Kim HO, Jung KU, Chun HK, Park DI (2018) Prospective analysis of delayed colorectal post-polypectomy bleeding. Surg Endosc 32:3282–3289. https://doi.org/10.1007/s00464-018-6048-9

    Article  PubMed  Google Scholar 

  18. Kamal F, Khan MA, Khan S, Marella HK, Nelson T, Khan Z, Ahmad D, Tombazzi C, Ismail MK, Howden CW (2020) Prophylactic hemoclips in prevention of delayed post-polypectomy bleeding for ≥ 1 cm colorectal polyps: meta-analysis of randomized controlled trials. Endosc Int Open 8:E1102–E1110. https://doi.org/10.1055/a-1164-6315

    Article  PubMed  PubMed Central  Google Scholar 

  19. Chen B, Du L, Luo L, Cen M, Kim JJ (2021) Prophylactic clips to reduce delayed polypectomy bleeding after resection of large colorectal polyps: a systematic review and meta-analysis of randomized trials. Gastrointest Endosc 93:807–815. https://doi.org/10.1016/j.gie.2020.10.004

    Article  PubMed  Google Scholar 

  20. Albéniz E, Fraile M, Ibáñez B, Alonso-Aguirre P, Martínez-Ares D, Soto S, Gargallo CJ, Ramos Zabala F, Álvarez MA, Rodríguez-Sánchez J, Múgica F, Nogales Ó, Herreros de Tejada A, Redondo E, Guarner-Argente C, Pin N, León-Brito H, Pardeiro R, López-Roses L, Rodríguez-Téllez M, Jiménez A, Martínez-Alcalá F, García O, de la Peña J, Ono A, de las Parras FA, Pellisé M, Rivero L, Saperas E, Pérez-Roldán F, Pueyo-Royo A, Eguaras-Ros J, Zúñiga-Ripa A, Concepción-Martín M, Huelin-Álvarez, P, Colán-Hernández J, Cubiella J, Remedios D, i Caserras XB, López-Viedma B, Cobian J, González-Haba M, Santiago J, Martínez-Cara JG, Valdivielso E (2016) A scoring system to determine risk of delayed bleeding after endoscopic mucosal resection of large colorectal lesions. Clin Gastroenterol Hepatol 14:1140–1147. https://doi.org/10.1016/j.cgh.2016.03.021

    Article  Google Scholar 

  21. Ortiz O, Rex DK, Grimm IS, Moyer MT, Hasan MK, Pleskow D, Elmunzer BJ, Khashab MA, Sanaei O, Al-Kawas FH, Gordon SR, Mathew A, Levenick JM, Aslanian HR, Antaki F, von Renteln D, Crockett SD, Rastogi A, Gill JA, Law R, Wallace MB, Elias PA, MacKenzie TA, Pohl H, Pellisé M (2021) Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps. Endoscopy 53:1150–1159. https://doi.org/10.1055/a-1332-6727

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Fu Xing Hospital, Capital Medical University, #20, Fuxingmenwai Street, Xicheng District, Beijing, 100038, China

    Zheng Yu, Jing Hu, Peilin Li, Quan Li, Yaojun Hu, Jinpin Chen & Jinpeng Wang

  2. Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed Research Center, UPNA, Pamplona, IdiSNA, Spain

    Eduardo Albéniz

Authors
  1. Zheng Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eduardo Albéniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jing Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peilin Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Quan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yaojun Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jinpin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jinpeng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Zheng Yu contributed to the conception of the study; Zheng Yu and Jinpin Chen performed the search of databases; Yaojun Hu, Zheng Yu, and Jing Hu performed the literature screening and data extraction; Zheng Yu and Jinpeng Wang performed the data analyses; Zheng Yu, Peilin Li, and Quan li contributed to the manuscript and figure preparation; Eduardo Albéniz provided the data about Clip closure after resection of large colorectal lesions with substantial risk of bleeding and participated in the conception and revision of the article.

Corresponding author

Correspondence to Zheng Yu.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 188 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, Z., Albéniz, E., Hu, J. et al. Prevention of delayed post-polypectomy bleeding by prophylactic clipping after endoscopic colorectal polypectomy: a meta-analysis. Int J Colorectal Dis 37, 2229–2236 (2022). https://doi.org/10.1007/s00384-022-04253-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-022-04253-0

Keywords

Search

Navigation