Endoscopy 2021; 53(S 01): S84-S85
DOI: 10.1055/s-0041-1724468
Abstracts | ESGE Days
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Saturday, 27 March 2021 14:00 – 14:45 How to minimise bleeding after EMR/ESD Room 6

Prophylactic Clipping For The Prevention Of Delayed Bleeding After Non-Pedunculated Colorectal Polyp Resection: An Individual Patient Data Meta-Analysis

A Turan
1   Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
,
H Pohl
2   VA White River Junction, Section of Gastroenterology and Hepatology, Vermont, United States
,
M Matsumoto
3   Department of Gastroenterology, Sapporo Medical Center NTT EC, Sapporo, Japan
,
B Lee
4   Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, California, United States
,
M Aizawa
5   Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu, Japan
,
F Desideri
6   Sant’Andrea Hospital, Sapienza University of Rome, Digestive and Liver Disease Department, Endoscopy Unit, Rome, Italy
7   Gastroenterology Department, San Maurizio Hospital, Bolzano, Italy
,
E Albéniz
8   Department of Gastroenterology, Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain
,
G Raju
9   University of Texas MD Anderson Cancer Center, Houston, United States,
,
D Luba
1   Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
0   Monterey Bay Gastroenterology Consultants, Monterey, United States
,
M Barret
11   Department of Gastroenterology, Cochin Hospital, AP-HP, Université de Paris, Paris, France
,
S Gurudu
12   Department of Gastroenterology, Mayo Clinic, Scottsdale, United States
,
F Ramirez
12   Department of Gastroenterology, Mayo Clinic, Scottsdale, United States
,
W-R Lin
13   Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Province of China
,
F Atsma
14   Department of IQ Healthcare, Radboudumc, Radboud Institute for Health Sciences, Nijmegen, Netherlands
,
D Rex
15   Department of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, United States
,
B Lim
4   Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, California, United States
16   Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, United States
,
K Kwok
17   Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, United States
,
K Togashi
5   Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu, Japan
,
R Coriat
11   Department of Gastroenterology, Cochin Hospital, AP-HP, Université de Paris, Paris, France
,
S Umar
12   Department of Gastroenterology, Mayo Clinic, Scottsdale, United States
,
Chen C-W
13   Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, Province of China
,
J Terhaar sive Droste
18   Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ‘s Hertogenbosch, Netherlands
,
R Schrauwen
19   Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, Netherlands
,
G Kemper
1   Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
,
P Siersema
1   Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
,
E van Geenen
1   Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Netherlands
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    Aims Non-pedunculated colorectal polyps are usually endoscopically removed to prevent neoplastic progression. Delayed bleeding is the most common adverse event. Clipping of the resection defect has been suggested to reduce delayed bleedings. The aim of this study was to determine if prophylactic clipping reduces delayed bleedings and to analyze the contribution of polyp characteristics, extent of defect closure and routine antithrombotic use.

    Methods An Individual Patient Data Meta-Analysis (IPDMA) was performed. Studies on prophylactic clipping in non-pedunculated colorectal polyps were selected from PubMed, Embase, Web of Science and Cochrane database (last selection: April 2020) and authors of eligible studies were invited to share original study data. The primary outcome was delayed bleeding ≤30 days. Multivariable mixed modeling was used to determine the efficacy of prophylactic clipping in various subgroups adjusted for confounders. Sensitivity analyses were performed on a per patient and polyp level.

    Results Data of 5,380 patients with 8,948 resected polyps were included from three RCT’s, two prospective and eight retrospective studies. Prophylactic clipping was found to reduce delayed bleeding in proximal polyps ≥20 mm (adjusted OR 0.62; 95 % CI 0.44 – 0.88; p<0.01), especially when patients used routine antithrombotics and when complete closure of the resection defect was achieved. Prophylactic clipping did not benefit distal polyps ≥20 mm when patients used routine antithrombotics (adjusted OR 1.41; 95 % CI 0.79 – 2.52; p=0.24). Sensitivity analyses confirmed these results.

    Conclusions Prophylactic clipping reduces delayed bleeding after resection of non-pedunculated proximal colorectal polyps ≥20 mm, especially when patients use routine antithrombotics and when complete closure is achieved. No benefit was found for distal polyps ≥20 mm, independent of antithrombotic use. Our results further identify which patients may benefit from prophylactic clipping.

    Citation: Turan A, Pohl H, Matsumoto M et al. OP204 PROPHYLACTIC CLIPPING FOR THE PREVENTION OF DELAYED BLEEDING AFTER NON-PEDUNCULATED COLORECTAL POLYP RESECTION: AN INDIVIDUAL PATIENT DATA META-ANALYSIS. Endoscopy 2021; 53: S84.


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    Publication History

    Article published online:
    19 March 2021

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