Mo1674 EFFICACY OF PROPHYLACTIC CLIPPING FOR POST-POLYPECTOMY BLEEDING: A SYSTEMIC REVIEW AND META-ANALYSIS

Abstract

Bleeding after polypectomy is the most common complication associated with colonoscopy. It is unclear whether prophylactic closure of mucosal defects with endoclip prevents delayed bleeding. Given the discrepancies in current literature, we performed a meta-analysis evaluating the efficacy of clip placement in the prevention of post-polypectomy bleeding. A comprehensive search of multiple databases including Embase, Scopus, MEDLINE/PubMed, CINAHL, and Cochrane since inception through November 2019 was conducted. We included case control, cohort studies and clinical trials. Using the DerSimonian and Laird (random effects) model with odds ratio (OR), a meta-analysis was performed for delayed post-polypectomy bleeding (DPB) with prophylactic clip placement versus no prophylactic clip. We also assessed the risk of perforation with prophylactic clip placement. A total of 20 studies (12 randomized controlled trials and 8 observational studies) with 17492 patients were included in the analysis. Follow-up after polypectomy ranged from 7 days to 30 days. Among the included studies, a total of 27,758 polypectomies were performed. The rate of DPB in patients with prophylactic clip placement was 1.39% (119/8514) compared to 1.01% (196/19244) with no prophylactic clip. Meta-analysis of all studies showed no difference for DPB with clip vs no clip (OR 1.01, 95% Confidence Interval (CI), 0.54-1.89). There was significant heterogeneity among the included studies with in I2=83% (Figure). Nine studies assessed the risk of perforation with clip placement and found no difference in rate of perforation with prophylactic clip versus no clip (OR 0.73, 95% CI, 0.27-1.99), I2=0%). A total of 7 studies assessed the efficacy of prophylactic clips for polyps >20mm. Subgroup analysis showed decreased risk of bleeding with prophylactic clips for polyps >20mm (OR, 0.45 (95% CI, 0.25-0.79), I2=27%). Three studies accessed the efficacy of prophylactic clips for proximal polyps of any size. Subgroup analysis of those studies showed no difference of bleeding with prophylactic clips vs no clips (OR 0.80, 95% CI, 0.27-2.38), I2=79%). Based on this analysis, prophylactic endoclip placement appears beneficial in reducing DPB for large polyp (>20mm) resection at colonoscopy. There was no increase in the rate of perforation with endoclip placement. Consideration should be given to prophylactic endoclip placement after polypectomy of large colon polyps.