Effect Of Prophylactic Clipping Following Endoscopic Resection Of Colorectal Polyps On Delayed Post-polypectomy Bleeding: A Meta-analysis

Objective:Bleeding is the most common severe complication after colorectal polypectomy.Assess the effect of prophylactic clipping following endoscopic resection of colorectal polyps on delayed post-polypectomy bleeding(DPB)through a meta-analysis of randomized controlled trials.Methods:A search was performed in databases of PubMed,EMBASE and Cochrane Library.Articles were finally included according to the inclusion and exclusion criteria.Inclusion criteria are:RCT;patients undergoing endoscopic resection for colorectal polyps;lesion closure with clips as test group;non-clipping without any extra bleeding prevention as control group;DPB as outcome.The risk of bias table included in Cochrane Handbook for Systematic Reviews of Interventions was used for quality evaluation.After date extraction,RevMan was used to calculate the pooled odds ratio(OR)and performed subgroup analysis.I~2 test was used to evaluate the heterogeneity.Using Stata to produce a funnel plot and run Egger test evaluate publication bias.The sensitivity analysis of overall effect was performed by excluding each single study.Results:Nine RCTs were included in this study.Prophylactic clipping was associated with a lower incidence of DPB(1.8%)when compared to no clipping(2.7%)(pooled OR:0.65,95%CI:0.48-0.88,P:0.006,I~2:38%).Prophylactic clipping following EMR was associated with a lower incidence of DPB when compared to no clipping(pooled OR:0.47,95%CI:0.30-0.75,P:0.001,I~2:0%).The risk reduction seemed mainly with larger polyps(?20mm)(pooled OR:0.52,95%CI:0.33-0.82,P:0.005,I~2:0%),non-pedunculated polyps(pooled OR:0.44,95%CI:0.30-0.65,P<0.0001,I~2:0%)and proximal colonic location(pooled OR:0.50,95%CI:0.32-0.80,P:0.004,I~2:37%).The protective effect was not seen in small polyps(<20mm)(pooled OR:0.81,95%CI:0.53-1.25,P:0.34,I~2:33%)or pedunculated polyps (pooled OR:1.62,95%CI:0.86-3.06,P:0.14,I~2:0%).All studies were of high quality.No publication bias or heterogeneity was present.There was no significant heterogeneity among the studies.The sensitivity analysis indicated the results were stable,and the Egger method did not show publication bias.Conclusion:Prophylactic clipping following endoscopic resection of colorectal polyps reduces DPB incidence.The effect may be more obvious when polys are larger than 20mm,non-pedunculated,located at proximal colon or have a combination of these features.