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Prophylactic clipping to prevent delayed colonic post-polypectomy bleeding: meta-analysis of randomized and observational studies

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Abstract

Background and aims

Delayed post-polypectomy bleeding (DPPB) is a commonly described adverse event following polypectomy. Prophylactic clipping may prevent DPPB in some patient subgroups. We performed a meta-analysis to assess both the efficacy and real-world effectiveness of prophylactic clipping.

Methods

We performed a database search through March 2020 for clinical trials or observational studies assessing prophylactic clipping and DPPB. Pooled risk ratios (RR) were calculated using random effects models. Subgroup, sensitivity, and meta-regression analyses were performed to elucidate clinical or methodological factors associated with effects on outcomes.

Results

A total of 2771 citations were screened, with 11 randomized controlled trials (RCTs) and 9 observational studies included, representing 24,670 colonoscopies. DPPB occurred in 2.0% of patients overall. The pooled RR of DPPB was 0.47 (95% CI 0.29–0.77) from RCTs enrolling only patients with polyps ≥ 20 mm. Remaining pooled RCT data did not demonstrate a benefit for clipping. The pooled RR of DPPB was 0.96 (95% CI 0.61–1.51) from observational studies including all polyp sizes. For patients with proximal polyps of any size, the RR was 0.73 (95% CI 0.33–1.62) from RCTs. Meta-regression confirmed that polyp size ≥ 20 mm significantly influenced the effect of clipping on DPPB.

Conclusion

Pooled evidence demonstrates a benefit when clipping polyps measuring ≥ 20 mm, especially in the proximal colon. In lower-risk subgroups, prophylactic clipping likely results in little to no difference in DPPB.

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Abbreviations

CENTRAL:

Cochrane Central Registry of Controlled Trials

CI:

Confidence interval

CRC:

Colorectal cancer

DPPB:

Delayed post-polypectomy bleeding

EMBASE:

Excerpta Medica Database

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

MOOSE:

Meta-analysis of Observational Studies in Epidemiology

NOS:

Newcastle-Ottawa scale

OR:

Odds ratio

PRISMA:

Referred Reporting Items for Systematic Reviews and Meta-analyses

RCT:

Randomized control trial

ROB:

Risk of bias

RR:

Risk ratio

References

  1. Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, Cercek A, Smith RA, Jemal A (2020) Colorectal cancer statistics, 2020. CA Cancer J Clin 70:145–164

    Article  PubMed  Google Scholar 

  2. Doubeni CA, Corley DA, Quinn VP, Jensen CD, Zauber AG, Goodman M, Johnson JR, Mehta SJ, Becerra TA, Zhao WK, Schottinger J, Doria-Rose VP, Levin TR, Weiss NS, Fletcher RH (2018) Effectiveness of screening colonoscopy in reducing the risk of death from right and left colon cancer: a large community-based study. Gut 67:291–298

    Article  PubMed  Google Scholar 

  3. Miller EA, Pinsky PF, Schoen RE, Prorok PC, Church TR (2019) Effect of flexible sigmoidoscopy screening on colorectal cancer incidence and mortality: long-term follow-up of the randomised US PLCO cancer screening trial. Lancet Gastroenterol Hepatol 4:101–110

    Article  PubMed  Google Scholar 

  4. 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. New Engl J Med 369:1095–1105

    Article  CAS  PubMed  Google Scholar 

  5. Shaukat A, Mongin SJ, Geisser MS, Lederle FA, Bond JH, Mandel JS, Church TR (2013) Long-term mortality after screening for colorectal cancer. N Engl J Med 369:1106–1114

    Article  CAS  PubMed  Google Scholar 

  6. Kwon MJ, Kim YS, Bae SI, Park YI, Lee KJ, Min JH, Jo SY, Kim MY, Jung HJ, Jeong SY, Yoon WJ, Kim JN, Moon JS (2015) Risk factors for delayed post-polypectomy bleeding. Intest Res 13:160–165

    Article  PubMed  PubMed Central  Google Scholar 

  7. Forbes N, Hilsden RJ, Kaplan GG, James MT, Lethebe C, Maxwell C, Heitman SJ (2019) Practice patterns and predictors of prophylactic endoscopic clip usage during polypectomy. Endosc Int Open 7:E1051-e1060

    Article  PubMed  PubMed Central  Google Scholar 

  8. Shah ED, Pohl H, Rex DK, Wallace MB, Crockett SD, Morales SJ, Feagins LA, Law R (2020) Valuing innovative endoscopic techniques: prophylactic clip closure after endoscopic resection of large colon polyps. Gastrointest Endosc 91:1353–1360

    Article  PubMed  Google Scholar 

  9. Forbes N, Frehlich L, James M, Hilsden R, Kaplan G, Wilson T, Lorenzetti D, Tate D, Bourke M, Heitman S (2019) Routine prophylactic endoscopic clipping is not efficacious in the prevention of delayed post-polypectomy bleeding: a systematic review and meta-analysis of randomized controlled trials. J Can Assoc Gastroenterol 2:105–117

    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

    Article  PubMed  Google Scholar 

  11. Albeniz E, Alvarez MA, Espinos JC, Nogales O, Guarner C, Alonso P, Rodriguez-Tellez M, Herreros de Tejada A, Santiago J, Bustamante-Balen M, Rodriguez Sanchez J, Ramos-Zabala F, Valdivielso E, Martinez-Alcala F, Fraile M, Elosua A, Guerra Veloz MF, Ibanez Beroiz B, Capdevila F, Enguita-German M (2019) Clip closure after resection of large colorectal lesions with substantial risk of bleeding. Gastroenterology 157:1213-1221.e1214

    Article  PubMed  Google Scholar 

  12. 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.e973

    Article  PubMed  Google Scholar 

  13. Forbes N, Hilsden RJ, Lethebe BC, Maxwell CM, Lamidi M, Kaplan GG, James MT, Razik R, Hookey LC, Ghali WA, Bourke MJ, Heitman SJ (2020) Prophylactic endoscopic clipping does not prevent delayed postpolypectomy bleeding in routine clinical practice: a propensity score-matched cohort study. Am J Gastroenterol 115:774–782

    Article  PubMed  PubMed Central  Google Scholar 

  14. Spadaccini M, Albeniz E, Pohl H, Maselli R, Chandrasekar VT, Correale L, Anderloni A, Carrara S, Fugazza A, Badalamenti M, Iwatate M, Antonelli G, Enguita-German M, Alvarez MA, Sharma P, Rex DK, Hassan C, Repici A (2020) Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: meta-analysis of randomized trials. Gastroenterology 159:148-158.e11

    Article  PubMed  Google Scholar 

  15. Fujiya M, Tanaka K, Dokoshi T, Tominaga M, Ueno N, Inaba Y, Ito T, Moriichi K, Kohgo Y (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81:583–595

    Article  PubMed  Google Scholar 

  16. Sherman RE, Anderson SA, Dal Pan GJ, Gray GW, Gross T, Hunter NL, LaVange L, Marinac-Dabic D, Marks PW, Robb MA, Shuren J, Temple R, Woodcock J, Yue LQ, Califf RM (2016) Real-world evidence - what is it and what can it tell us? New Engl J Med 375:2293–2297

    Article  PubMed  Google Scholar 

  17. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012

    Article  CAS  PubMed  Google Scholar 

  18. Moher D, Shamseer L, 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 statement. Syst Rev 4:1

    Article  PubMed  PubMed Central  Google Scholar 

  19. Higgins J, Green S (2011) Cochrane Handbook for Systematic Reviews of Interventions. https://training.cochrane.org/handbook/current. Accessed 16 Nov2020.

  20. Sterne J, Hernan M, Reeves B, Savovic J, Berkman N, Viswanathan M (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454

    Article  PubMed  Google Scholar 

  22. Watabe H, Yamaji Y, Okamoto M, Kondo S, Ohta M, Ikenoue T, Kato J, Togo G, Matsumura M, Yoshida H, Kawabe T, Omata M (2006) Risk assessment for delayed hemorrhagic complication of colonic polypectomy: polyp-related factors and patient-related factors. Gastrointest Endosc 64:73–78

    Article  PubMed  Google Scholar 

  23. Zhang Q, An S, Chen Z, Fu FH, Jiang B, Zhi F, Bai Y, Gong W (2014) Assessment of risk factors for delayed colonic post-polypectomy hemorrhage: a study of 15553 polypectomies from 2005 to 2013. PLoS One 9:e108290

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Sawhney MS, Salfiti N, Nelson DB, Lederle FA, Bond JH (2008) Risk factors for severe delayed postpolypectomy bleeding. Endoscopy 40:115–119

    Article  CAS  PubMed  Google Scholar 

  25. Gimeno-Garcia AZ, de Ganzo ZA, Sosa AJ, Perez DN, Quintero E (2012) Incidence and predictors of postpolypectomy bleeding in colorectal polyps larger than 10 mm. Eur J Gastroenterol Hepatol 24:520–526

    Article  PubMed  Google Scholar 

  26. Kim JH, Lee HJ, Ahn JW, Cheung DY, Kim JI, Park SH, Kim JK (2013) Risk factors for delayed post-polypectomy hemorrhage: a case-control study. J Gastroenterol Hepatol 28:645–649

    Article  PubMed  Google Scholar 

  27. Qumseya BJ, Wolfsen C, Wang Y, Othman M, Raimondo M, Bouras E, Wolfsen H, Wallace MB, Woodward T (2013) Factors associated with increased bleeding post-endoscopic mucosal resection. J Dig Dis 14:140–146

    Article  CAS  PubMed  Google Scholar 

  28. Wu XR, Church JM, Jarrar A, Liang J, Kalady MF (2013) Risk factors for delayed postpolypectomy bleeding: how to minimize your patients’ risk. Int J Colorect Dis 28:1127–1134

    Article  Google Scholar 

  29. Buddingh KT, Herngreen T, Haringsma J, van der Zwet WC, Vleggaar FP, Breumelhof R, Ter Borg F (2011) Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage: a multi-center case-control study. Am J Gastroenterol 106:1119–1124

    Article  PubMed  Google Scholar 

  30. Burgess NG, Metz AJ, Williams SJ, Singh R, Tam W, Hourigan LF, Zanati SA, Brown GJ, Sonson R, Bourke MJ (2014) Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 12:651-661.e651-653

  31. Bahin FF, Rasouli KN, Byth K, Hourigan LF, Singh R, Brown GJ, Zanati SA, Moss A, Raftopoulos S, Williams SJ, Bourke MJ (2016) Prediction of clinically significant bleeding following wide-field endoscopic resection of large sessile and laterally spreading colorectal lesions: a clinical risk score. Am J Gastroenterol 111:1115–1122

    Article  PubMed  Google Scholar 

  32. Metz AJ, Bourke MJ, Moss A, Williams SJ, Swan MP, Byth K (2011) Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions. Endoscopy 43:506–511

    Article  CAS  PubMed  Google Scholar 

  33. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  PubMed  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. Chang K, Lee BS, Tekeste T, Nguyen A, Adeyemo M, Girgis A, Kwok KK, Crowson HM, Burris AO, Attam R, Chaya CT, Durbin TE, Giap AQ, Hunt GC, Iskander J, Kao KT, Lim BS (2020) The effect of prophylactic hemoclips on the risk of delayed post-endoscopic mucosal resection bleed for upper and lower gastrointestinal lesions: a retrospective cohort study. BMC Gastroenterol 20:60

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926

    Article  PubMed  PubMed Central  Google Scholar 

  38. 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

    Google Scholar 

  39. Liaquat H, Rohn E, Rex DK (2013) Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 77:401–407

    Article  PubMed  Google Scholar 

  40. Burgess NG, Williams SJ, Hourigan LF, Brown GJ, Zanati SA, Singh R, Tam W, Butt J, Byth K, Bourke MJ (2014) A management algorithm based on delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions. Clin Gastroenterol Hepatol 12:1525–1533

    Article  PubMed  Google Scholar 

  41. Congly S, Forbes N, Hilsden R, Clement F, Bourke M, Heitman S (2020) Prophylactic clipping to prevent delayed post-polypectomy bleeding following removal of large proximal polyps: an economic evaluation. Gastroenterology: submitted

  42. 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 (2020) Prophylactic clipping is not effective in preventing post-polypectomy bleeding for <20-mm colon polyps: a multicenter open-label randomized controlled trial. J Gastroenterol Hepatol. https://doi.org/10.1111/jgh/15134

  43. Soh JS, Seo M, Kim KJ (2020) Prophylactic clip application for large pedunculated polyps before snare polypectomy may decrease immediate postpolypectomy bleeding. BMC Gastroenterol 20:68

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Forbes N, Heitman S, Bourke M (2020) When evaluating the benefit of prophylactic Clipping collowing polypectomy, not All of the answers are found in randomized trials. Gastroenterology. https://doi.org/10.1053/j.gastro.2020.04.080

  45. Paspatis GA, Paraskeva K, Theodoropoulou A, Mathou N, Vardas E, Oustamanolakis P, Chlouverakis G, Karagiannis I (2006) A prospective, randomized comparison of adrenaline injection in combination with detachable snare versus adrenaline injection alone in the prevention of postpolypectomy bleeding in large colonic polyps. Am J Gastroenterol 101:2805, quiz 2913

  46. 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

    Article  PubMed  Google Scholar 

  47. Quintanilla E, Castro JL, Rábago LR, Chico I, Olivares A, Ortega A, Vicente C, Carbó J, Gea F (2012) Is the use of prophylactic hemoclips in the endoscopic resection of large pedunculated polyps useful? A prospective and randomized study. J Interv Gastroenterol 2:183–188

    Article  PubMed  PubMed Central  Google Scholar 

  48. 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

    Article  PubMed  PubMed Central  Google Scholar 

  49. 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. Digest Endosc 28:570–576

    Article  Google Scholar 

  50. Fukata M, Kijima H, Sanjo A, Sugisaka H, Inoue T, Takagi I (2002) Prophylactic clipping may not eliminate delayed hemorrhage in colonoscopic polypectomies. Jikeikai Med J 39:133–142

    Google Scholar 

  51. Dior M, Coriat R, Tarabichi S, Leblanc S, Polin V, Perkins G, Dhooge M, Prat F, Chaussade S (2013) Does endoscopic mucosal resection for large colorectal polyps allow ambulatory management? Surg Endosc 27:2775–2781

    Article  PubMed  Google Scholar 

  52. Feagins LA, Nguyen AD, Iqbal R, Spechler SJ (2014) The prophylactic placement of hemoclips to prevent delayed post-polypectomy bleeding: an unnecessary practice? A case control study. Dig Dis Sci 59:823–828

    Article  PubMed  Google Scholar 

  53. 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 Ó Nogales F, Herreros de Tejada A, Redondo E, Pin N, León-Brito H, Pardeiro R, López-Roses L, Rodríguez-Téllez M, Jiménez A, Martínez-Alcalá F, García O, Peña de la J, Ono A, Las de A, Parras F, 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, Bessa ICX, López-Viedma B, Cobian J, González-Haba M, Santiago J, Martínez-Cara JG, Valdivielso E, Guarner-Argente C (2016) A scoring system to determine risk of delayed bleeding after endoscopic mucosal resection of large colorectal lesions. Clin Gastroenterol Hepatol 14:1140–1147

    Article  PubMed  Google Scholar 

  54. Tsuruta S, Tominaga N, Ogata S, Tsuruoka N, Sakata Y, Shimoda R, Eguchi Y, Anzai K, Hara M, Fujimoto K (2019) Risk factors for delayed hemorrhage after colonic endoscopic mucosal resection in patients not on antithrombotic therapy: retrospective analysis of 3844 polyps of 1660 patients. Digestion 100:86–92

    Article  PubMed  Google Scholar 

  55. Chen CW, Kuo CJ, Chiu CT, Su MY, Lin CJ, Le PH, Lim SN, Yeh CT, Alison MR, Lin WR (2020) The effect of prophylactic hemoclip placement and risk factors of delayed post-polypectomy bleeding in polyps sized 6 to 20 millimeters: a propensity score matching analysis. BMC Gastroenterol 20:309

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Kirles Bishay and ZhaoWu Meng have contributed equally.

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, University of Calgary, TRW 6D19, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Kirles Bishay, Zhao Wu Meng, Matthew T. James, Gilaad G. Kaplan, Robert J. Hilsden, Steven J. Heitman & Nauzer Forbes

  2. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

    Levi Frehlich, Matthew T. James, Gilaad G. Kaplan, Robert J. Hilsden, Steven J. Heitman & Nauzer Forbes

  3. Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia

    Michael J. Bourke

  4. Westmead Clinical School, University of Sydney, Sydney, NSW, Australia

    Michael J. Bourke

  5. Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, AB, Canada

    Robert J. Hilsden, Steven J. Heitman & Nauzer Forbes

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Contributions

NF conceived of and designed the study and co-drafted the manuscript and is the guarantor of the manuscript. KB and ZWM co-drafted the manuscript. All authors analysed and interpreted the data. All authors critically revised the manuscript for intellectual content. All authors approved the final version of the manuscript.

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Correspondence to Nauzer Forbes.

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Disclosures

Dr. Forbes is a consultant for Boston Scientific, is on the speakers’ bureau for Pentax Medical and has received unrelated funding from Pentax Medical. Dr. Kaplan is a speaker and/or consultant for AbbVie, Janssen, Pfizer, Gilead and Takeda and has received unrelated research funding from Ferring, Janssen, AbbVie, GlaxoSmithKline, Merck and Shire. Dr. Bourke has received unrelated research funding from Cook Medical, Olympus Medical, and Boston Scientific. Dr. James has received unrelated research funding from AmGen Canada. All disclosures are unrelated to this work. Dr. Bishay, Dr. Meng, Mr. Frehlich, Dr. Hilsden and Dr. Heitman have no potential conflicts of interest or financial ties to disclose.

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Bishay, K., Meng, Z.W., Frehlich, L. et al. Prophylactic clipping to prevent delayed colonic post-polypectomy bleeding: meta-analysis of randomized and observational studies. Surg Endosc 36, 1251–1262 (2022). https://doi.org/10.1007/s00464-021-08398-x

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