Prophylactic clipping of large, proximal lesions cuts postpolypectomy bleeding

Routine prophylactic clipping after polypectomy may not decrease postoperative bleeding, a new meta-analysis has found. However, it may reduce bleeding after the excision of large proximal lesions.

Researchers retrieved nine randomized controlled trials from the databases of Medline, Embase, and Scopus, corresponding to 7,197 colorectal lesions in 4,557 patients. The outcome was the comparison of clipping (n=2,288) vs not clipping (n=2,269) to prevent bleeding after polypectomy. Patient age ranged from 60.5 to 72.7 years.

The risk of postpolypectomy bleeding in the control group was 3.3 percent, as opposed to only 2.2 percent in patients who underwent prophylactic clipping. This did not correspond to a significant difference in risk (risk ratio [RR], 0.69, 95 percent confidence interval [CI], 0.45–1.08; p=0.072).

However, meta-regression analysis discovered that prophylactic clipping became more useful against postpolypectomy bleeding as the percentage of large lesions increased. In particular, every 10-percent increase in the percentage of large lesions led to an 8-percent drop in the RR of delayed bleeding after clipping.

Subgroup analysis confirmed the meta-regression findings. Clipping almost halved the risk of postpolypectomy bleeding in polyps ≥20 mm in size (RR, 0.51, 95 percent CI, 0.33–0.78). No benefit was reported for polyps <20 mm (RR, 1.04, 95 percent CI, 0.60–1.79).

Location likewise had a role to play on clipping efficacy. The risk of delayed bleeding was significantly lowered in proximal lesions (RR, 0.53, 95 percent CI, 0.35–0.81), while clipping had no effect on distal lesions (RR, 1.01, 95 percent CI, 0.43–2.37).