Although prophylactic clip application before polypectomy may prevent postpolypectomy bleeding (PPB), the usefulness of prophylactic clipping in the treatment of large pedunculated polyps is controversial in some prospective randomized studies. This study was conducted to evaluate the efficacy of prophylactic clip application and to investigate the predictors of PPB in large pedunculated colorectal polyps. A total of 137 pedunculated polyps (size ≥1 cm) in 116 patients were prospectively included and randomized into group A (with clipping) and group B (without clipping), and resected. The occurrences of immediate PPB (graded 1–4) and delayed PPB were compared. Sixty-seven polyps were allocated in group A and 70 polyps in group B. In both groups, the median polyp diameter was 15 mm (P = 0.173) and the median stalk diameter was 3 mm (P = 0.362). Twenty-eight (20.4%) immediate PPB episodes in 137 polyps occurred, 6 (9.0%) in group A and 22 (31.4%) in group B (P = 0.001). However, the occurrence of delayed PPB was not different between the groups (P = 0.943). Prophylactic clip application decreased the occurrence of immediate PPB (odds ratio 0.215, 95% confidence interval 0.081–0.571). Moreover, polyp size ≥20 mm and stalk diameter ≥ 4 mm increased the risk of immediate PPB. Clip application before polypectomy of ≥1 cm pedunculated polyps is effective in decreasing the occurrence of immediate PPB. Thus, clip application should be considered before performing snare polypectomy, especially for large polyps with a thick stalk. This research was studied a prospective maneuver and enrolled in a registry of clinical trials run by United States National Library of Medicine at the National Institutes of Health (ClinicalTrials.gov Protocol Registration and Results system ID: NCT01437631). This study was registered on September 19, 2011.

中文翻译：

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圈套息肉切除术前对大的有蒂息肉进行预防性钳夹可减少息肉切除术后的立即出血

尽管在息肉切除术前应用预防性钳夹可以预防息肉切除术后出血（PPB），但在一些前瞻性随机研究中，预防性钳夹在治疗大有蒂息肉中的有效性尚存争议。进行这项研究以评估预防性应用夹子的功效，并研究大型带蒂大肠息肉中PPB的预测因子。前瞻性纳入116例患者中的137个带蒂息肉，大小≥1 cm，随机分为A组（夹闭）和B组（不夹闭），并切除。比较了即时PPB（1-4级）和延迟PPB的发生率。A组分配了67个息肉，B组分配了70个息肉。两组中，息肉的中位直径为15 mm（P = 0.173），茎秆的中位直径为3 mm（P = 0.362）。137例息肉中有28例（20.4％）立即发生PPB发作，A组6例（9.0％），B组22例（31.4％）（P = 0.001）。但是，两组间PPB延迟的发生率无差异（P = 0.943）。预防性应用夹子可减少即刻PPB的发生（几率0.215，95％置信区间0.081-0.571）。此外，息肉大小≥20mm和茎直径≥4 mm会增加立即发生PPB的风险。息肉切除术前≥1 cm带蒂息肉的夹子应用可有效减少即刻PPB的发生。因此，在进行圈套息肉切除术之前，应考虑使用夹子，特别是对于茎粗的大息肉。这项研究进行了一项前瞻性研究，并纳入了美国国立卫生研究院美国国家医学图书馆进行的临床试验注册（ClinicalTrials.gov方案注册和结果系统ID：NCT01437631）。该研究于2011年9月19日注册。