Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2019; 25(18): 2251-2263
Published online May 14, 2019. doi: 10.3748/wjg.v25.i18.2251
Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis
Fares Ayoub, Donevan R Westerveld, Justin J Forde, Christopher E Forsmark, Peter V Draganov, Dennis Yang
Fares Ayoub, Donevan R Westerveld, Justin J Forde, Department of Medicine, University of Florida, Gainesville, FL 32608, United States
Christopher E Forsmark, Peter V Draganov, Dennis Yang, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL 32608, United States
Author contributions: Ayoub F and Westerveld DR performed the literature search, performed data collection, performed quality assessment, drafted and revised manuscript; Forde JJ performed quality assessment and revised manuscript; Ayoub F performed statistical analysis; Yang D designed study, evaluated included studies, drafted and revised manuscript; Draganov PV, Forsmark CE provided critical input and revised manuscript.
Conflict-of-interest statement: The authors declare that no conflict of interest exists. There are no financial or other competing interests for principal investigators, patients included or any member of the trial.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dennis Yang, MD, Assistant Professor, Doctor, Division of Gastroenterology, Hepatology and Nutrition, University of Florida, 1329 SW 16th Street, Gainesville, FL 32608, United States. dennis.yang@medicine.ufl.edu
Telephone: +1-352-2739474 Fax: +1-352-6279002
Received: January 24, 2019
Peer-review started: January 24, 2019
First decision: March 14, 2019
Revised: March 22, 2019
Accepted: May 2, 2019
Article in press: May 3, 2019
Published online: May 14, 2019
Processing time: 110 Days and 16.1 Hours
Abstract
BACKGROUND

The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes.

AIM

To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection (EMR) of colorectal lesions ≥ 20 mm.

METHODS

We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I2 were used to test for heterogeneity. Pooling was conducted using a random-effects model.

RESULTS

Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB (1.4%) when compared to no clipping (5.2%) (pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm. There was no significant heterogeneity among the studies (I2 = 0%, P = 0.67).

CONLUSION

Prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.

Keywords: Meta-analysis; Clipping; Endoscopic resection; Endoscopic mucosal resection

Core tip: The role of prophylactic clipping for the prevention of delayed polypectomy bleeding (DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes. We conducted a meta-analysis that included 7794 polyps in 1701 cases of endoscopic mucosal resection (EMR) and found that prophylactic clipping may reduce DPB following EMR of large colorectal lesions. Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.