Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis

Ayoub, Fares; Westerveld, Donevan; Forde, Justin; Forsmark, Christopher E.; Draganov, Peter V.; Yang, Dennis

doi:10.3748/wjg.v25.i18.2251

Cited by 40 publications

(32 citation statements)

References 34 publications

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“…found that prophylactic clipping did not reduce the occurrence of delayed bleeding after colorectal endoscopic resection regardless of the lesion size, which the vast majority of the cases enrolled in the analysis are lesions < 20 mm (2847 out of 3059; 93%). However, another meta‐analysis conducted focusing on colorectal lesions ≥ 20 mm suggested that prophylactic clipping could reduce delayed bleeding following EMR, 37 which was consistent with our results. Therefore, we speculate that prophylactic endoscopic closure may be an effective solution to prevent delayed bleeding after ESD or EMR for large colorectal lesions.…”

Section: Discussionsupporting

confidence: 91%

Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis

Liu

Zhang

Wang

et al. 2020

J of Gastro and Hepatol

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Background and Aim Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large colorectal lesions. However, colorectal ESD is associated with a high frequency of adverse events (AEs), and the efficacy of prophylactic endoscopic closure after ESD for preventing AEs is still controversial. This meta‐analysis was conducted to assess the efficacy of closure on AEs following colorectal ESD. Methods We searched PubMed, Embase, and the Cochrane Library for eligible studies. The chi‐square‐based Q statistics and the I2 test were used to test for heterogeneity. Pooling was conducted using a fixed or random effects model. Results We identified eight eligible studies that compared the effects of closure vs non‐closure with respect to delayed bleeding, delayed perforation, and post‐ESD coagulation syndrome. Compared with non‐closure (5.2%), closure was associated with a lower incidence (0.9%) of delayed bleeding (pooled odd ratios [ORs]:0.19, 95% CI: 0.08–0.49) following ESD. The pooled ORs showed no significant differences in incidence of delayed perforation (pooled OR: 0.22; 95% CI: 0.05–1.03) or post‐ESD coagulation syndrome (pooled OR:0.75; 95% CI: 0.26–2.18) between the closure and non‐closure groups. Conclusion Prophylactic endoscopic closure may reduce the incidence of delayed bleeding following ESD of colorectal lesions. Future studies are needed to further illuminate risk factors and stratify high risk subjects for a cost‐effective preventive strategy.

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Section: Discussionsupporting

confidence: 91%

Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis

Liu

Zhang

Wang

et al. 2020

J of Gastro and Hepatol

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“…Two previous meta-analyses [23,24] showed conflicting results while evaluating the role of HC placement in prevention of DPPB. Forbes et al [23] also included only RCTs but showed no benefit of HCs in prevention of DPPB; pooled RR (95 % CI) 0.86 (0.55, 1.36).…”

Section: Discussionmentioning

confidence: 99%

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

Kamal

Khan

et al. 2020

Endosc Int Open

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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.

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“…49 In contrast, in a separate randomized trial in 1,098 patients undergoing polypectomy of nonpedunculated polyps ≥10 mm, there was no benefit with closure of mucosal defects using prophylactic endoscopic clipping in reducing the rate of delayed PPB, and this finding was consistent with that obtained for large polyps (≥20 mm). 50 Several systematic reviews and meta-analyses [51][52][53][54][55][56] have consistently shown a similar lack of benefit of prophylactic endoscopic clipping of mucosal defects of nonpedunculated polyps up to 19 mm, with inconclusive benefits for nonpedunculated polyps ≥20 mm. This heterogeneity in polyps ≥20 mm could be due to variations in the polyp location that have not been accounted for in most studies, as was reported in the previously mentioned randomized trial 49 in which a benefit was noted only in the proximal colon.…”

Section: Prevention Of Post-polypectomy Bleedingmentioning

confidence: 99%

Endoscopic Management of Post-Polypectomy Bleeding

Gutta

Gromski

2020

Clin Endosc

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Post-polypectomy bleeding (PPB) is one of the most common complications of endoscopic polypectomy. There are multiple risk factors related to patient and polyp characteristics that should be considered. In most cases, immediate PPB can be effectively managed endoscopically when recognized and managed promptly. Delayed PPB can manifest in a myriad of ways. In severe delayed PPB, resuscitation for hemodynamic stabilization should be prioritized, followed by endoscopic evaluation and therapy once the patient is stabilized. Future areas of research in PPB include the risks of direct oral anticoagulants and of specific electrosurgical settings for hot-snare polypectomy vs. cold-snare polypectomy, benefits of closure of post-polypectomy mucosal defects using through-the-scope clips, and prospective comparative evaluation of newer hemostasis agents such as hemostatic spray powder and over-the-scope clips.Clin Endosc 2020;53:302-310

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Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis

Cited by 40 publications

References 34 publications

Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis

Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis

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

Endoscopic Management of Post-Polypectomy Bleeding

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