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Effectiveness of prophylactic clipping in preventing post-polypectomy bleeding in aspirin users – a propensity-score analysis

Published:October 06, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.024
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      Abstract

      Background and Aims

      Anti-thrombotics use is a significant risk factor of post-polypectomy bleeding (PPB). Evidence of prophylactic clipping is only available for proximal and large colonic lesions in general population. Dedicated studies to examine the benefit of prophylactic clipping in patients on aspirin remain scarce.

      Methods

      A propensity-score weighted retrospective cohort study was performed in a tertiary referral center from January 2018 to September 2021. Patients who received aspirin and underwent colonoscopic polypectomy, endoscopic mucosal resection or endoscopic submucosal dissection were included. Data on baseline demographics, medications and endoscopic factors (polyp number, size, location, morphology, resection method and prophylactic clipping) were captured. Propensity-score weighting models were developed between prophylactic clipping and no clipping groups. The primary outcome was delayed PPB within 30 days, with a composite endpoint consisting of repeated colonoscopy for hemostasis, requirement of blood transfusion or hemoglobin drop of greater than 2g/dL.

      Results

      Total 1,373 patients with 3,952 polyps were included. Baseline characteristics were balanced between two groups. In the multivariate analysis, the largest polyp size was a significant risk factor for PPB (odds ratio (OR) 1.07, 95%CI 1.02-1.11, p=0.002). Prophylactic clipping was not associated with a reduced risk of PPB (OR 1.34, 95%CI 0.83-2.18, p=0.240) and did not show any risk reduction in subgroups with different polyp sizes, locations and endoscopic resection techniques.

      Conclusion

      Prophylactic clipping was not associated with a lower risk of PPB in aspirin users after endoscopic resection of colorectal polyps. Aspirin use should not be regarded as the only factor for the routine use of prophylactic clips.

      Keywords

      Acronyms and Abbreviations:

      ASMD (Absolute Standardized Mean Difference), ATE (Average Treatment Effect), CDARS (Clinical Data Analysis and Reporting System), CMS (Clinical Management System), EMR (Endoscopic Mucosal Resection), ESD (Endoscopic Submucosal Dissection), GBM (Generalized Boosted Models), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), IPTW (Inverse Probability of Treatment Weighting), OR (Odds Ratio), PPB (Post-polypectomy Bleeding), PS (Propensity Score), SD (Standard Deviation), 95%CI (95% Confidence Interval)
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