Endoscopy 2020; 52(S 01): S112-S113
DOI: 10.1055/s-0040-1704347
ESGE Days 2020 oral presentations
Saturday, April 25, 2020 08:30 – 10:30 Large colonic polyps: Slice and dice The Liffey B
© Georg Thieme Verlag KG Stuttgart · New York

EFFECT OF PROPHYLACTIC CLIPPING FOLLOWING COLORECTAL RESECTION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

M Spadaccini
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
2   Humanitas University, Department of Biomedical Sciences, Rozzano, Italy
,
E Albéniz
3   Complejo Hospitalario de Navarra, Digestive Endoscopy Unit, Pamplona, Spain
,
H Pohl
4   Dartmouth Geisel School of Medicine, Digestive Endoscopy Unit, Hanover, USA
,
R Maselli
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
,
VT Chandrasekar
5   Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, USA
,
L Correale
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
,
A Anderloni
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
,
S Carrara
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
,
A Fugazza
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
,
E Vespa
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
2   Humanitas University, Department of Biomedical Sciences, Rozzano, Italy
,
P Sharma
5   Kansas City VA Medical Center, Gastroenterology and Hepatology, Kansas City, USA
,
DK Rex
6   Indiana University School of Medicine, Digestive Endoscopy Unit, Indianapolis, USA
,
C Hassan
7   Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
,
A Repici
1   Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy
2   Humanitas University, Department of Biomedical Sciences, Rozzano, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims The efficacy of prophylactic clipping for post-polypectomy bleeding(PPB) prevention is still controversial, and data from previous meta-analyses are inconclusive. We performed a systematic review and meta-analysis of randomized controlled trials(RCTs) to assess the efficacy of prophylactic clipping for preventing PPB following high- and low-risk resections.

    Methods We searched electronic databases (Medline/Pubmed,EMBASE,Scopus) for RCTs assessing the efficacy of prophylactic clipping for the prevention of PPB. Pooled relative risks were determined using fixed-or random-effects models.Sub-group analysis and meta-regression analysis were also performed based on size and location. To investigate the stability of our results, we also performed the leave-one-out sensitivity analysis.

    Results From 1691 records, 9 RCTs satisfied all the inclusion criteria. Studies were published between 2003 and 2019, in USA(n=3), in Europe(n=1) and in Asia(n=5). A total of 7197 colorectal lesions (3544 clipped and 3653 unclipped) were resected in4557 patients and included for the analysis. Lesion characteristics in term of mean size (average mean polyp size,18.6mm), and location (mean percentage of proximal polyps 49.2%) were comparable between clipping and non-clipping group. . Compared with not clipping, clipping did not reduce the risk of PPB(RR,0.69; 95%CI:0.45-1.08;p=0.072). However, significant risk reductions were detected for≥20mm polyps (7.6% vs 4.3%; RR=0.51; 95% CI:0.33-0.78; P = 0.020) and proximally located lesions (6.2% vs 3.0%; RR=0.53, 95% CI:0.35-0.81, p< 0.001), while no reduction was shown when clipping< 20 mm or distal lesions. At multivariate analysis, the proportion of lesions ≥20 mm was associated with the risk ratio of PPB (ORs, 0.91; 95% CI: 0.85-0.98 per 1-unit increase, p=0.012). No publication bias was identified.

    Conclusions Overall, there was little evidence of a protective effect of prophylactic clipping for prevention of PPB. However, there was a clear evidence of the benefit from clipping use for lesions at higher risk of bleeding, including lesions ≥20mm and proximal polyps.


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