| Research purpose:To evaluate the effect of using endoclip to prevent delayed post-polypectomy bleeding.Methods:Search in the web of science,Pub Med,EMBASE,Cochrane Library,CNKI,Wanfang database,Sinomed,and VIP Chinese Journal Database for RCTs related to prevention of post-polypectomy bleeding.The Chinese and English articles related to the purpose were achieved from the above databases until January 2020.The quality evaluation of methodology was carried out for all the trials included in our research.Use Revman manage 5.3 statistical software for meta analysis.The main outcome was delayed bleeding rate,and the secondary outcomes included perforation rate,post-polypectomy coagulation syndrome rate and abdominal pain rate.Results:A total of 13 randomized controlled trails,which were included a total of 5197 adult patients with colorectal polyps diagnosed and resected by colonoscopy.The results of meta-analysis showed that:1.The total delayed bleeding rate:there was no significant heterogeneity among the 13 articles included(I~2=18%,P=0.26),the bleeding risk of the clip group was lower than that of the control group(1.8%vs2.8%),RR=0.63;95%CI:0.47-0.85;P=0.003,the difference was statistically significant.As for the polyps,diameter≥20mm,5 trails showed no significant heterogeneity(I~2=0%,P=0.48)between the studies,and the bleeding rate in the clip group was lower than that in the control group(3.8%vs 7.5%),with significant statistically difference(P=0.003),RR=0.51,95%CI:0.33-0.79;there was no heterogeneity between the studies between the polyps that diameter≥40mm(I~2=0%,P=0.49),the bleeding rate of the clip group was lower than that of the control group(4.1%vs 9.1%),the difference was not statistically significant(P=0.06),RR=0.44,95%CI:0.18-1.05.2.Perforation rate:7 trails reported the perforation rate after operation.The heterogeneity test results were I~2=0%,P=0.81.In the clip group,The perforation rate was lower than that in the control group(0.6%vs 1.0%),with no significant difference between the two groups(P=0.27),RR=0.63,95%CI:0.28-1.42.3.Incidence of PPCS:5 articles reported the incidence of PPCS.The results of heterogeneity test showed moderate heterogeneity(I~2=41%,P=0.15).In the clip group,the PPCS rate was higher than that in the control group(4.2%vs3.8%),no significant difference was between the two groups(P=0.54),RR=1.14,95%CI:0.75-1.73.When excluded a trail with a greater impact on heterogeneity,I~2=0%,P=0.64,meta analysis showed that the incidence of PPCS in the clip group was higher than that in the control group(5.0%vs 3.6%),with no significant difference between the two groups(P=0.11),RR=1.43,95%CI:0.92-2.24.4.Incidence of abdominal pain:3 trails recorded the incidence of abdominal pain.The heterogeneity test showed that there was a high degree of heterogeneity(I~2=78%,P=0.010).After excluding the article with a greater impact,I~2=0%,P=0.41.The incidence of abdominal pain in the clip group was lower than that in the control group(1.0%vs4.9%).The difference between the two groups was statistically significant(P=0.0002),RR=0.20,95%CI:0.08-0.47.Conclusion:After endoscopic resection of colorectal polyps,the incidence of delayed bleeding and abdominal pain can be reduced by using clip.It’s confused that such effectiveness would be assessed with polyps whose diameter≥40 mm.Prophylactic closure had no significant impact on the occurrence of postoperative perforation and electrocoagulation syndrome. |
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