Spadaccini Marco, Albéniz Eduardo, Pohl Heiko, Maselli Roberta, Thoguluva Chandrasekar Viveksandeep, Correale Loredana, Anderloni Andrea, Carrara Silvia, Fugazza Alessandro, Badalamenti Matteo, Iwatate Mineo, Antonelli Giulio, Enguita-Germán Mónica, Álvarez Marco Antonio, Sharma Prateek, Rex Douglas K, Hassan Cesare, Repici Alessandro
Humanitas Research Hospital, Digestive Endoscopy Unit, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Rozzano, Italy.
Navarrabiomed Research Institute/Public University of Navarra/IdiSNA, Endoscopy Research Department, Pamplona, Spain.
Gastroenterology. 2020 Jul;159(1):148-158.e11. doi: 10.1053/j.gastro.2020.03.051. Epub 2020 Apr 1.
BACKGROUND & AIMS: The benefits of prophylactic clipping to prevent bleeding after polypectomy are unclear. We conducted an updated meta-analysis of randomized trials to assess the efficacy of clipping in preventing bleeding after polypectomy, overall and according to polyp size and location.
We searched the MEDLINE/PubMed, Embase, and Scopus databases for randomized trials that compared the effects of clipping vs not clipping to prevent bleeding after polypectomy. We performed a random-effects meta-analysis to generate pooled relative risks (RRs) with 95% CIs. Multilevel random-effects metaregression analysis was used to combine data on bleeding after polypectomy and estimate associations between rates of bleeding and polyp characteristics.
We analyzed data from 9 trials, comprising 71897 colorectal lesions (22.5% 20 mm or larger; 49.2% with proximal location). Clipping, compared with no clipping, did not significantly reduce the overall risk of postpolypectomy bleeding (2.2% with clipping vs 3.3% with no clipping; RR, 0.69; 95% confidence interval [CI], 0.45-1.08; P = .072). Clipping significantly reduced risk of bleeding after removal of polyps that were 20 mm or larger (4.3% had bleeding after clipping vs 7.6% had bleeding with no clipping; RR, 0.51; 95% CI, 0.33-0.78; P = .020) or that were in a proximal location (3.0% had bleeding after clipping vs 6.2% had bleeding with no clipping; RR, 0.53; 95% CI, 0.35-0.81; P < .001). In multilevel metaregression analysis that adjusted for polyp size and location, prophylactic clipping was significantly associated with reduced risk of bleeding after removal of large proximal polyps (RR, 0.37; 95% CI, 0.22-0.61; P = .021) but not small proximal lesions (RR, 0.88; 95% CI, 0.48-1.62; P = .581).
In a meta-analysis of randomized trials, we found that routine use of prophylactic clipping does not reduce risk of postpolypectomy bleeding overall. However, clipping appeared to reduce bleeding after removal of large (more than 20 mm) proximal lesions.
预防性钳夹术预防息肉切除术后出血的益处尚不清楚。我们对随机试验进行了一项更新的荟萃分析，以评估钳夹术在预防息肉切除术后出血方面的疗效，包括总体疗效以及根据息肉大小和位置的疗效。
我们在MEDLINE/PubMed、Embase和Scopus数据库中检索了比较钳夹术与未钳夹术预防息肉切除术后出血效果的随机试验。我们进行了随机效应荟萃分析，以生成具有95%置信区间（CI）的合并相对风险（RR）。使用多水平随机效应元回归分析来合并息肉切除术后出血的数据，并估计出血率与息肉特征之间的关联。
我们分析了9项试验的数据，包括71897个结直肠病变（22.5%直径20毫米或更大；49.2%位于近端）。与未钳夹相比，钳夹术并未显著降低息肉切除术后出血的总体风险（钳夹术组出血率为2.2%，未钳夹术组为3.3%；RR为0.69；95%置信区间[CI]为0.45 - 1.08；P = 0.072）。钳夹术显著降低了切除直径20毫米或更大息肉（钳夹术后4.3%出血，未钳夹术后7.6%出血；RR为0.51；95% CI为0.33 - 0.78；P = 0.020）或近端位置息肉（钳夹术后3.0%出血，未钳夹术后6.2%出血；RR为0.53；95% CI为0.35 - 0.81；P < 0.001）后的出血风险。在根据息肉大小和位置进行调整的多水平元回归分析中，预防性钳夹术与切除大型近端息肉后出血风险降低显著相关（RR为0.37；95% CI为0.22 - 0.61；P = 0.021），但与小型近端病变无关（RR为0.88；95% CI为0.48 - 1.62；P = 0.581）。
在一项随机试验的荟萃分析中，我们发现常规使用预防性钳夹术并不能总体上降低息肉切除术后出血的风险。然而，钳夹术似乎能降低切除大型（超过20毫米）近端病变后的出血风险。
