Nishizawa Toshihiro, Suzuki Hidekazu, Goto Osamu, Ogata Haruhiko, Kanai Takanori, Yahagi Naohisa
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
United European Gastroenterol J. 2017 Oct;5(6):859-867. doi: 10.1177/2050640616687837. Epub 2017 Jan 11.
The efficacy of clipping for preventing delayed bleeding after colorectal endoscopic resection is still controversial. To assess the efficacy of prophylactic clipping, we conducted a meta-analysis of randomized controlled trials.
We searched PubMed, the Cochrane library, and the Igaku-chuo-zasshi database for randomized trials eligible for inclusion in our meta-analysis. We identified seven eligible randomized trials from the database search, and compared the effect of clipping versus non-clipping with respect to delayed bleeding and perforation. Data from eligible studies were combined to calculate pooled odds ratios (ORs).
Postoperative bleeding was observed in 41 of 1526 cases (2.7%) without clipping and in 32 of 1533 cases (2.1%) with clipping (OR 0.76, 95% CI: 0.39-1.47, = 0.414). There was no significant heterogeneity among the trial results (I-Square = 26.7%, = 0.22). In the subgroup analysis based on small tumor size (<20 mm) and large tumor size (≥20 mm), there were no significant differences. Compared with non-clipping, the pooled OR of developing perforation with clipping was 1.00 (95% CI: 0.14-7.25), indicating no significant difference between the two groups.
Prophylactic clipping did not decrease the occurrence of delayed bleeding after colorectal endoscopic resection. Clipping could be of interest in patients with a high risk of bleeding (anticoagulation) or large lesions, but with the available trials data to prove this are scarce.
结直肠内镜切除术后预防性夹闭预防迟发性出血的疗效仍存在争议。为评估预防性夹闭的疗效，我们进行了一项随机对照试验的荟萃分析。
我们检索了PubMed、Cochrane图书馆和《医学中央杂志》数据库，以查找符合纳入我们荟萃分析条件的随机试验。我们从数据库检索中确定了7项符合条件的随机试验，并比较了夹闭与未夹闭在迟发性出血和穿孔方面的效果。合并符合条件研究的数据以计算合并比值比（OR）。
1526例未进行夹闭的患者中有41例（2.7%）发生术后出血，1533例进行夹闭的患者中有32例（2.1%）发生术后出血（OR 0.76，95%CI：0.39 - 1.47，P = 0.414）。试验结果之间无显著异质性（I² = 26.7%，P = 0.22）。在基于小肿瘤大小（<20mm）和大肿瘤大小（≥20mm）的亚组分析中，无显著差异。与未夹闭相比，夹闭后发生穿孔的合并OR为1.00（95%CI：0.14 - 7.25），表明两组之间无显著差异。
预防性夹闭并未降低结直肠内镜切除术后迟发性出血的发生率。对于出血风险高（抗凝治疗）或病变较大的患者，夹闭可能是有意义的，但现有试验数据尚不足以证明这一点。
