574 Role of Prophylactic Endoscopic Clipping for Prevention of Delayed Post-Polypectomy Bleeding: Meta-Analysis of Randomized Controlled Trials
Bibliographic record
Abstract
INTRODUCTION: Post-polypectomy bleeding is a common complication of colonoscopy. Several endoscopic techniques including prophylactic endoscopic clip placement are used for prevention of post-polypectomy bleeding. However, several studies have reported mixed results on the efficacy of this approach. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of prophylactic endoscopic clipping for prevention of delayed post-polypectomy bleeding. METHODS: Several databases (Embase, Pubmed, Cochrane database, Google Scholar) and abstracts of gastrointestinal and surgical meetings were searched extensively for relevant articles. Studies comparing prophylactic endoscopic clipping alone to standard colonoscopy with no endoscopic clipping were included. Studies that combined prophylactic clipping with other hemostatic techniques were excluded. Data was extracted using a standard form by two reviewers. Data regarding patient characteristics, types of polyps resected, post-polypectomy bleeding and other complications were extracted. Effect sizes were computed either using the fixed effects or random effects model using the Comprehensive Meta-analysis software. Publication bias, quality of studies and heterogeneity were analyzed. RESULTS: Nine RCTs were included in this study. The studies recruited subjects from USA, Japan, Canada and Spain. There were 3762 controls and 3658 patients in the treatment arm. Studies evaluated both small (<20mm) and large polyps (>20 mm), sessile and pedunculated polyps. The polyps were predominantly removed with standard polypectomy or endoscopic mucosal resection (for larger polyps). Delayed post-polypectomy bleeding occurred in 2.4% of controls and 1.6% in patients with endoscopic clipping. On analysis of all polyps, prophylactic endoscopic clipping decreased the risk of delayed post-polypectomy bleeding (RR = 0.71: 95% CI 0.51-0.99, P = 0.04, I 2 = 20%). The risk reduction was seen mainly with larger polyps(>20 mm), RR = 0.53 (95% CI : 0.32-.90, P = 0.02, NNT 28) and with sessile polyps (RR = 0.52, 95% CI: 0.32-0.83, P = 0.006, NNT 100). The protective effect was not seen for small polyps (<20 mm) ( P = 0.91, P = 0.7) or pedunculated polyps (RR = 0.58, P = 0.29). All studies were of high quality. No publication bias or heterogeneity was present. CONCLUSION: Prophylactic clipping decreased the risk of delayed post-polypectomy bleeding. The benefit was mainly seen in patients with sessile polyps or large polyps (>20 mm).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.055 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.023 | 0.054 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".