PGY-III internal medicine resident Geisinger Medical Center Danville, PA
Umair Iqbal, MD1, Osama Siddique, MD2, Harshit S. Khara, MD, FACG1, Hafsa Anwar, MD3, Khwaja F. Haq, MD4, Muhammad A. Karim, MD5, Muhammad Ali Khan, MD6, John W. Birk, MD2; 1Geisinger Medical Center, Danville, PA; 2University of Connecticut, Farmington, CT; 3Capital Health Medical Center, Hopewell Township, NJ; 4Henry Ford Hospital/Wayne State University, Detroit, MI; 5Imam Clinic, Karachi, Sindh, Pakistan; 6University of Alabama, Birmingham, AL
Introduction: Delayed post-polypectomy bleeding (DPPB) is a common complication after colonoscopic polypectomy, and recent guidelines have somewhat cleared the muddy waters. The size of the polyp which qualifies for prophylactic clip closure to prevent DPPB still remains debated. This study aimed to review prophylactic clip placement on polyps >1 cm in reducing DPPB. Methods: We conducted a systematic literature search on several databases including PubMed, Embase and Ovid Medline until January 2020 to identify all potential studies that evaluated the utility of prophylactic clipping in decreasing the risk of DPPB. All the analysis was performed using RevMan 5.3 software. Results: Twenty-nine studies [17 randomized controlled trials (RCTs) and 12 observational studies] with 24,280 patients were included in the meta-analysis. Out of 24,280, 7478 patient had clipping done and 16802 had no prophylactic clipping done. There was no significant difference in risk of DPPB in patients who had clipping and no clipping with OR=1.16 [0.68-1.99] with significant heterogeneity (I2=80%). In a subgroup analysis, six studies including 3249 patients with >1 cm non-pedunculated polyp was included to evaluate if prophylactic clipping has any benefit in lowering the risk of DPPB. Clipping was performed in 1525 patient and 1724 patients had no clipping done. Prophylactic clipping is associated with lower odds of DPPB with OR=0.66 [0.45-0.99] with no heterogeneity. In another subgroup analysis including only RCTs, prophylactic clipping is associated with lower odds of DPPB with OR=0.74 [0.47-1.15]. Risk of DPPB is significantly higher in patients on anticoagulation or dual antiplatelets therapy with OR=2.96 [2.22-3.94] and use of prophylactic clipping will be beneficial is these patients. Discussion: In contrast to previous studies, our review and analysis of literature reflect that patients with polyp > 1 cm had a significant reduction in DPPB with prophylactic clip closure. It also found no significant reduction in DPPB between prophylactic clip closure of right versus left colon polyps. Our study raises new questions on whether an approach of reserving prophylactic clipping of large ( > 2 cm) polyps might result in a higher complication rate with DPPB.
Disclosures: Umair Iqbal indicated no relevant financial relationships. Osama Siddique indicated no relevant financial relationships. Harshit Khara indicated no relevant financial relationships. Hafsa Anwar indicated no relevant financial relationships. Khwaja Haq indicated no relevant financial relationships. Muhammad Karim indicated no relevant financial relationships. Muhammad Ali Khan indicated no relevant financial relationships. John Birk indicated no relevant financial relationships.