TY - JOUR
T1 - Clip closure to prevent adverse events after EMR of proximal large nonpedunculated colorectal polyps
T2 - meta-analysis of individual patient data from randomized controlled trials
AU - Forbes, Nauzer
AU - Gupta, Sunil
AU - Frehlich, Levi
AU - Meng, Zhao Wu
AU - Ruan, Yibing
AU - Montori, Sheyla
AU - Chebaa, Benjamin R.
AU - Dunbar, Kerry B.
AU - Heitman, Steven J.
AU - Feagins, Linda A
AU - Albéniz, Eduardo
AU - Pohl, Heiko
AU - Bourke, Michael J.
N1 - Funding Information:
DISCLOSURE: The following authors disclosed financial relationships: N. Forbes: Consultant for Boston Scientific, Pentax Medical, and Pendopharm; speaker for Boston Scientific and Pentax Medical; research support from Pentax Medical. S. J. Heitman: Consultant for Pendopharm. H. Pohl: Research support from Steris and Cosmo Pharmaceuticals. M. J. Bourke: Research support from Olympus, Cook Medical, and Boston Scientific. All other authors disclosed no financial relationships.
Publisher Copyright:
© 2022 American Society for Gastrointestinal Endoscopy
PY - 2022/11
Y1 - 2022/11
N2 - Background and Aims: After EMR, prophylactic clipping is often performed to prevent clinically significant post-EMR bleeding (CSPEB) and other adverse events (AEs). Prior evidence syntheses have lacked sufficient power to assess clipping in relevant subgroups or in nonbleeding AEs. We performed a meta-analysis of individual patient data (IPD) from randomized trials assessing the efficacy of clipping to prevent AEs after EMR of proximal large nonpedunculated colorectal polyps (LNPCPs) ≥20 mm. Methods: We searched EMBASE, MEDLINE, Cochrane Central Registry of Controlled Trials, and PubMed from inception to May 19, 2021. Two reviewers screened citations in duplicate. Corresponding authors of eligible studies were invited to contribute IPD. A random-effects 1-stage model was specified for estimating pooled effects, adjusting for patient sex and age and for lesion location and size, whereas a fixed-effects model was used for traditional meta-analyses. Results: From 3145 citations, 4 trials were included, representing 1248 patients with proximal LNPCPs. The overall rate of CSPEB was 3.5% and 9.0% in clipped and unclipped patients, respectively. IPD were available for 1150 patients, in which prophylactic clipping prevented CSPEB with an odds ratio (OR) of. 31 (95% confidence interval [CI],. 17-.54). Clipping was not associated with perforation or abdominal pain, with ORs of. 78 (95% CI,. 17-3.54) and. 67 (95% CI,. 20-2.22), respectively. Conclusions: Prophylactic clipping is efficacious in preventing CSPEB after EMR of proximal LNPCPs. Therefore, clip closure should be considered a standard component of EMR of LNPCPs in the proximal colon.
AB - Background and Aims: After EMR, prophylactic clipping is often performed to prevent clinically significant post-EMR bleeding (CSPEB) and other adverse events (AEs). Prior evidence syntheses have lacked sufficient power to assess clipping in relevant subgroups or in nonbleeding AEs. We performed a meta-analysis of individual patient data (IPD) from randomized trials assessing the efficacy of clipping to prevent AEs after EMR of proximal large nonpedunculated colorectal polyps (LNPCPs) ≥20 mm. Methods: We searched EMBASE, MEDLINE, Cochrane Central Registry of Controlled Trials, and PubMed from inception to May 19, 2021. Two reviewers screened citations in duplicate. Corresponding authors of eligible studies were invited to contribute IPD. A random-effects 1-stage model was specified for estimating pooled effects, adjusting for patient sex and age and for lesion location and size, whereas a fixed-effects model was used for traditional meta-analyses. Results: From 3145 citations, 4 trials were included, representing 1248 patients with proximal LNPCPs. The overall rate of CSPEB was 3.5% and 9.0% in clipped and unclipped patients, respectively. IPD were available for 1150 patients, in which prophylactic clipping prevented CSPEB with an odds ratio (OR) of. 31 (95% confidence interval [CI],. 17-.54). Clipping was not associated with perforation or abdominal pain, with ORs of. 78 (95% CI,. 17-3.54) and. 67 (95% CI,. 20-2.22), respectively. Conclusions: Prophylactic clipping is efficacious in preventing CSPEB after EMR of proximal LNPCPs. Therefore, clip closure should be considered a standard component of EMR of LNPCPs in the proximal colon.
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U2 - 10.1016/j.gie.2022.05.020
DO - 10.1016/j.gie.2022.05.020
M3 - Review article
C2 - 35667388
AN - SCOPUS:85140081998
SN - 0016-5107
VL - 96
SP - 721-731.e2
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -