The role of clips in preventing delayed bleeding after colorectal polyp resection: an individual patient data meta-analysis.

Non-pedunculated colorectal polyps are normally endoscopically removed to prevent neoplastic progression. Delayed bleeding is the most common major adverse event. Clipping the resection defect has been suggested to reduce delayed bleedings. Our aim was to determine if prophylactic clipping reduces delayed bleedings and to analyze the contribution of polyp characteristics, extent of defect closure and antithrombotic use.An Individual Patient Data Meta-Analysis was performed. Studies on prophylactic clipping in non-pedunculated colorectal polyps were selected from PubMed, Embase, Web of Science and Cochrane database (last selection: April 2020). Authors were invited to share original study data. The primary outcome was delayed bleeding ≤30 days. Multivariable mixed models were used to determine the efficacy of prophylactic clipping in various subgroups adjusted for confounders.Data of 5,380 patients with 8,948 resected polyps were included from three RCT's, two prospective and eight retrospective studies. Prophylactic clipping reduced delayed bleeding in proximal polyps ≥20 mm (OR 0.62; 95% CI 0.44 - 0.88; Number Needed to Treat [NNT] = 32), especially with antithrombotics (OR 0.59; 95% CI 0.35 - 0.99; NNT = 23; subgroup of anticoagulants/double platelet inhibitors N=226; OR 0.40; 95% CI 0.16 - 1.01; NNT = 12). Prophylactic clipping did not benefit distal polyps ≥20 mm with antithrombotics (OR 1.41; 95% CI 0.79 - 2.52).Prophylactic clipping reduces delayed bleeding after resection of non-pedunculated, proximal colorectal polyps ≥20 mm, especially in patients using antithrombotics. No benefit was found for distal polyps. Based on this study, patients can be identified who may benefit from prophylactic clipping. (PROSPERO registration number CRD42020104317).

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Authors: Ayla S Turan, Heiko Pohl, Mio Matsumoto, Brian S Lee, Masato Aizawa, Federico Desideri, Eduardo Albéniz, Gottumukkala S Raju, Daniel Luba, Maximilien Barret, Suryakanth R Gurudu, Francisco C Ramirez, Wey-Ran Lin, Femke Atsma, Peter D Siersema, Erwin J M van Geenen, Prophylactic Clipping Collaborative Group, Douglas K Rex, Brian S Lim, Karl K Kwok, Kazutomo Togashi, Romain Coriat, Sarah B Umar, Chun-Wei Chen, Jochim Terhaar Sive Droste, Ruud Schrauwen, Gijs Kemper