Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2019; 25(18): 2251-2263
Published online May 14, 2019. doi: 10.3748/wjg.v25.i18.2251
Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis
Fares Ayoub, Donevan R Westerveld, Justin J Forde, Christopher E Forsmark, Peter V Draganov, Dennis Yang
Fares Ayoub, Donevan R Westerveld, Justin J Forde, Department of Medicine, University of Florida, Gainesville, FL 32608, United States
Christopher E Forsmark, Peter V Draganov, Dennis Yang, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
Author contributions: Ayoub F and Westerveld DR performed the literature search, performed data collection, performed quality assessment, drafted and revised manuscript; Forde JJ performed quality assessment and revised manuscript; Ayoub F performed statistical analysis; Yang D designed study, evaluated included studies, drafted and revised manuscript; Draganov PV, Forsmark CE provided critical input and revised manuscript.
Conflict-of-interest statement: The authors declare that no conflict of interest exists. There are no financial or other competing interests for principal investigators, patients included or any member of the trial.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Dennis Yang, MD, Assistant Professor, Doctor, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1329 SW 16th Street, Gainesville, FL 32608, United States.
Telephone: +1-352-2739474 Fax: +1-352-6279002
Received: January 24, 2019
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
Research background

The role of prophylactic clipping in the prevention of delayed polypectomy bleeding (DPB) is unclear.

Research motivation

Previous meta-analyses included a variety of polyp resection methods and all polyp sizes, our analysis used a more focused approach.

Research objectives

To assess the effect of prophylactic clip placement on DPB after endoscopic mucosal resection (EMR) of colorectal lesions 20mm or larger.

Research methods

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).

Research results

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%).

Research conclusions

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.

Research perspectives

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.