Published online May 14, 2019. doi: 10.3748/wjg.v25.i18.2251
Peer-review started: January 24, 2019
First decision: March 14, 2019
Revised: March 22, 2019
Accepted: May 2, 2019
Article in press: May 3, 2019
Published online: May 14, 2019
The role of prophylactic clipping in the prevention of delayed polypectomy bleeding (DPB) is unclear.
Previous meta-analyses included a variety of polyp resection methods and all polyp sizes, our analysis used a more focused approach.
To assess the effect of prophylactic clip placement on DPB after endoscopic mucosal resection (EMR) of colorectal lesions 20mm or larger.
We performed a systematic search of Medline through PubMed and the Cochrane Library database for studies investigating the effect of prophylactic clipping on DPB following EMR of colorectal lesions. We used the PRISMA protocol for our analysis and assessed the quality of included articles using the Newcastle-Ottawa scale. We used RevMan version 5 for the statistical analysis, using the random-effects model (DeSimonian-Laird method).
A total of 7794 polyps in 13 studies were analyzed, including 1701 cases of EMR of lesions ≥ 20 mm. We found that prophylactic clipping following EMR of lesions ≥ 20 mm was associated with a lower rate of DPB (1.4%) compared to no clipping (5.2%).
Placement of clips prophylactically following EMR of colorectal lesions ≥ 20 mm may reduce rates of DPB and its associated morbidity and should be considered by practicing endoscopists in select patients.
Future prospective studies on the effect of clipping for DPB after EMR should focus on lesions ≥ 20 mm since those represent the highest risk. Cost analyses must also be conducted to implement the most cost-effective strategies for DPB prevention.