Introduction: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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.

中文翻译：

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常规临床实践中预防性内镜夹闭并不能预防息肉切除术后迟发性出血

简介：延迟性息肉切除术后出血（DPPB）是一种相对常见的不良事件。关于预防性截肢预防 DPPB 的有效性的证据存在争议，并且缺乏真实世界的有效性数据。我们的目的是确定预防性夹闭在大型筛查相关队列中预防 DPPB 的有效性。方法：我们手动审查了 2008 年至 2014 年在筛查机构接受息肉切除术的患者记录。收集内窥镜医生、患者和息肉相关数据。主要结局是 30 天内的 DPPB。所有计划外的医疗就诊均经过审查；DPPB 案件由委员会使用基于标准的词典进行裁决。进行多变量逻辑回归，得出剪裁和 DPPB 之间关联的调整优势比 (AOR)。除了倾向评分匹配和亚组分析之外，还对切除一颗息肉的手术进行了二次分析。结果：总共分析了 8,366 例涉及息肉切除术的结肠镜检查，产生 95 例 DPPB 事件。预防性夹闭与 DPPB 减少无关（AOR 1.27；0.83–1.96）。这些结果在单息肉队列中相似（n = 3,369，AOR 1.07；0.50-2.31）。在切除了一个近端息肉≥20毫米的患者中，AOR不显着，夹闭值为0.55（0.10-2.66）。在倾向评分匹配或其他亚组分析中，剪裁与保护性益处无关。讨论：在这项大型队列研究中，预防性夹闭与较低的 DPPB 率无关。内窥镜医师不应对大多数患者常规使用预防性夹闭。对于近端病变≥20 mm 的患者，需要进行额外的有效性和成本效益研究，对于这些患者，预防性夹闭可能发挥作用。