Prophylactic Endoscopic Clipping Does Not Prevent Delayed Postpolypectomy Bleeding in Routine Clinical Practice: A Propensity Score-Matched Cohort Study

• Published in: The American journal of gastroenterology Vol. 115; no. 5; pp. 774 - 782
• Main Authors: Forbes, Nauzer, Hilsden, Robert J, Lethebe, Brendan Cord, Maxwell, Courtney M, Lamidi, Mubasiru, Kaplan, Gilaad G, James, Matthew T, Razik, Roshan, Hookey, Lawrence C, Ghali, William A, Bourke, Michael J, Heitman, Steven J
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.05.2020; Wolters Kluwer
• Subjects: Ambulatory care; Clinical medicine; Cohort analysis; Cohort Studies; Colonic Polyps - surgery; Colonoscopy; Endoscopy; Female; Gastroenterology; Gastrointestinal Hemorrhage - prevention & control; Health facilities; Humans; Male; Medical screening; Middle Aged; Pathology; Patients; Polyps; Postoperative Complications - prevention & control; Prevention; Propensity Score
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/ajg.0000000000000585

Delayed postpolypectomy bleeding (DPPB) is a relatively common adverse event. Evidence is conflicting on the efficacy of prophylactic clipping to prevent DPPB, and real-world effectiveness data are lacking. We aimed to determine the effectiveness of prophylactic clipping in preventing DPPB in a large screening-related cohort. We manually reviewed records of patients who underwent polypectomy from 2008 to 2014 at a screening facility. Endoscopist-, patient- and polyp-related data were collected. The primary outcome was DPPB within 30 days. All unplanned healthcare visits were reviewed; DPPB cases were adjudicated by committee using a criterion-based lexicon. Multivariable logistic regression was performed, yielding adjusted odds ratios (AORs) for the association between clipping and DPPB. Secondary analyses were performed on procedures where one polyp was removed, in addition to propensity score-matched and subgroup analyses. In total, 8,366 colonoscopies involving polypectomy were analyzed, yielding 95 DPPB events. Prophylactic clipping was not associated with reduced DPPB (AOR 1.27; 0.83-1.96). These findings were similar in the single-polyp cohort (n = 3,369, AOR 1.07; 0.50-2.31). In patients with one proximal polyp ≥20 mm removed, there was a nonsignificant AOR with clipping of 0.55 (0.10-2.66). Clipping was not associated with a protective benefit in the propensity score-matched or other subgroup analyses. In this large cohort study, prophylactic clipping was not associated with lower DPPB rates. Endoscopists should not routinely use prophylactic clipping in most patients. Additional effectiveness and cost-effectiveness studies are required in patients with proximal lesions ≥20 mm, in whom there may be a role for prophylactic clipping.