Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
Section of Gastroenterology and Hepatology, VA White River Junction, White River Junction, Vermont.
Clin Gastroenterol Hepatol. 2022 Feb;20(2):362-371.e23. doi: 10.1016/j.cgh.2021.05.012. Epub 2021 May 12.
BACKGROUND & AIMS: Nonpedunculated colorectal polyps are normally endoscopically removed to prevent neoplastic progression. Delayed bleeding is the most common major adverse event. Clipping the resection defect has been suggested to reduce delayed bleedings. Our aim was to determine if prophylactic clipping reduces delayed bleedings and to analyze the contribution of polyp characteristics, extent of defect closure, and antithrombotic use.
An individual patient data meta-analysis was performed. Studies on prophylactic clipping in nonpedunculated colorectal polyps were selected from PubMed, Embase, Web of Science, and Cochrane database (last selection, April 2020). Authors were invited to share original study data. The primary outcome was delayed bleeding ≤30 days. Multivariable mixed models were used to determine the efficacy of prophylactic clipping in various subgroups adjusted for confounders.
Data of 5380 patients with 8948 resected polyps were included from 3 randomized controlled trials, 2 prospective, and 8 retrospective studies. Prophylactic clipping reduced delayed bleeding in proximal polyps ≥20 mm (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.44-0.88; number needed to treat = 32), especially with antithrombotics (OR, 0.59; 95% CI, 0.35-0.99; number needed to treat = 23; subgroup of anticoagulants/double platelet inhibitors: n = 226; OR, 0.40; 95% CI, 0.16-1.01; number needed to treat = 12). Prophylactic clipping did not benefit distal polyps ≥20 mm with antithrombotics (OR, 1.41; 95% CI, 0.79-2.52).
Prophylactic clipping reduces delayed bleeding after resection of nonpedunculated, proximal colorectal polyps ≥20 mm, especially in patients using antithrombotics. No benefit was found for distal polyps. Based on this study, patients can be identified who may benefit from prophylactic clipping. (PROSPERO registration number CRD42020104317.).
无蒂结直肠息肉通常通过内镜切除以防止肿瘤进展。延迟性出血是最常见的主要不良事件。夹闭切除缺损被认为可以减少延迟性出血。我们的目的是确定预防性夹闭是否可以减少延迟性出血，并分析息肉特征、缺损闭合程度和抗血栓药物使用的影响。
进行了一项个体患者数据的荟萃分析。从 PubMed、Embase、Web of Science 和 Cochrane 数据库（最后一次选择时间为 2020 年 4 月）中选择了关于无蒂结直肠息肉预防性夹闭的研究。邀请作者分享原始研究数据。主要结局为 30 天内发生的延迟性出血。多变量混合模型用于确定在调整混杂因素后，预防性夹闭在不同亚组中的疗效。
纳入了 3 项随机对照试验、2 项前瞻性研究和 8 项回顾性研究，共涉及 5380 名患者的 8948 个切除息肉的数据。预防性夹闭可降低≥20mm 的近端息肉（比值比 [OR]，0.62；95%置信区间 [CI]，0.44-0.88；需要治疗的人数 [NNT] = 32）和使用抗血栓药物（OR，0.59；95%CI，0.35-0.99；NNT = 23；抗栓剂/双重血小板抑制剂亚组：n = 226；OR，0.40；95%CI，0.16-1.01；NNT = 12）发生的延迟性出血。预防性夹闭对≥20mm 的远端息肉无获益，且抗血栓药物治疗（OR，1.41；95%CI，0.79-2.52）。
对于切除的无蒂结直肠息肉≥20mm 的近端息肉，预防性夹闭可降低延迟性出血的风险，尤其是在使用抗血栓药物的患者中。对于远端息肉无获益。根据本研究，可识别出可能从预防性夹闭中获益的患者。（PROSPERO 注册号：CRD42020104317。）
