CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(09): E1102-E1110
DOI: 10.1055/a-1164-6315
Review

Prophylactic hemoclips in prevention of delayed post-polypectomy bleeding for ≥ 1 cm colorectal polyps: meta-analysis of randomized controlled trials

Faisal Kamal
1   Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Muhammad A. Khan
2   Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, Alabama, United States
,
Salman Khan
3   Division of Gastroenterology, University of Arkansas Medical Sciences, Little Rock, AR
,
Hemnishil K. Marella
4   Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Tamara Nelson
5   Medical Sciences Library, University of Tennessee Health Science Center, Memphis, TN
,
Zubair Khan
6   Division of Gastroenterology, University of Texas-Houston, Houston, Texas, United
States
,
Dina Ahmad
1   Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Claudio Tombazzi
1   Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Mohammad K. Ismail
1   Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Colin W. Howden
1   Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
› Author Affiliations

Abstract

Background and aim Studies evaluating the role of prophylactic hemoclips (HC) in prevention of delayed post-polypectomy bleeding (DPPB) have reported conflicting results. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the role of prophylactic HC placement in prevention of DPPB for polyps ≥ 1 cm in size.

Methods We reviewed several databases to identify RCTs evaluating the role of HC in prevention of DPPB. The outcomes assessed included prevention of DPPB with polyps 1 to 1.9 cm, ≥ 2 cm, any polyp ≥ 1 cm, proximal colon polyps, distal colon polyps, and perforation. We analyzed data using a fixed effect model and reported summary pooled risk ratios (RR) with 95 % confidence intervals (CI). We assessed heterogeneity with the I2 statistic.

Results We included nine RCTs with 4550 patients. For polyps ≥ 2 cm, there was a statistically significantly lower risk of DPPB with use of HC; RR 0.55, 95 % CI 0.36, 0.86. There was also a statistically significantly lower risk for proximal colon polyps ≥ 2 cm; RR 0.41 (0.24, 0.70) but no significant difference for distal polyps; RR 1.23 (0.45, 3.32). There was also no significant difference in risk for polyps 1 to 1.9 cm; RR 1.07 (0.59, 1.97). There was no significant reduction in risk of perforation with HC use for any polyp size.

Conclusions Prophylactic HC placement is effective in prevention of DPPB from proximal colon polyps ≥ 2 cm, but of no significant benefit for polyps 1 to 1.9 cm in size or for distal colon polyps ≥ 2 cm.

Supplementary Fig. 1



Publication History

Received: 29 January 2020

Accepted: 01 April 2020

Publication Date:
31 August 2020 (online)

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