Prophylactic endoscopic clipping does not prevent delayed postpolypectomy bleeding

Last Updated: 2020-03-27

By Reuter Staff

NEW YORK (Reuters Health) - Prophylactic endoscopic clipping does not prevent delayed postpolypectomy bleeding (DPPB) and should not be used routinely in most patients, according to a new review of medical records.

Bleeding is the most common complication following endoscopic polypectomy. Immediate postpolypectomy bleeding is usually trivial, but DPPB can be clinically significant, leading to readmissions, changes in medical management and/or reinterventions.

Endoscopic clipping is a well-established treatment for immediate postpolypectomy bleeding, but there is conflicting evidence to support prophylactic endoscopic clipping to prevent DPPB.

Dr. Steven J. Heitman of Cumming School of Medicine, University of Calgary, in Canada, and colleagues used records from the Forzani and MacPhail Colon Cancer Screening Center to evaluate the effectiveness of prophylactic clipping in the prevention of DPPB.

They included more than 8,300 colonoscopies involving polypectomy (3,424 with clipping and 4,942 without).

There were 95 clinically significant DPPB events deemed definitely, probably, or possibly related to the index procedure, an overall event rate of 1.1%. DPPB was defined as any rectal bleeding resulting in presentation to an emergency department or inpatient healthcare facility within 30 days of a procedure that involved polypectomy.

There were 50 DPPB events in the clipped group and 45 in the unclipped group, a difference that was not statistically significant, the researchers report in The American Journal of Gastroenterology.

Results were similar in a separate analysis of procedures where only one polyp was removed.

Although no significant protective effect of clipping was seen in any clinically relevant subgroup analyzed, the point estimates for the odds of DPPB after clipping were below 1 for polyps 20 mm and larger and for single proximal polyps 20 mm or larger.

A propensity-score-matched analysis of 3,264 pairs of clipped and unclipped procedures also yielded disappointing results, with no significant differences between the groups in the odds of DPPB.

"Endoscopists should not routinely use prophylactic clipping in most patients," the authors conclude. "Additional effectiveness and cost-effectiveness studies are required in patients with proximal lesions 20 mm or larger, in whom there may be a role for prophylactic clipping."

Dr. Heitman did not respond to a request for comments.

SOURCE: https://bit.ly/2ye21Uh American Journal of Gastroenterology, online March 12, 2020.