PMID- 35667388 OWN - NLM STAT- MEDLINE DCOM- 20221025 LR - 20221123 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 96 IP - 5 DP - 2022 Nov TI - Clip closure to prevent adverse events after EMR of proximal large nonpedunculated colorectal polyps: meta-analysis of individual patient data from randomized controlled trials. PG - 721-731.e2 LID - S0016-5107(22)01733-3 [pii] LID - 10.1016/j.gie.2022.05.020 [doi] 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. CI - Copyright (c) 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Forbes, Nauzer AU - Forbes N AD - Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. FAU - Gupta, Sunil AU - Gupta S AD - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia. FAU - Frehlich, Levi AU - Frehlich L AD - Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. FAU - Meng, Zhao Wu AU - Meng ZW AD - Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. FAU - Ruan, Yibing AU - Ruan Y AD - Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada. FAU - Montori, Sheyla AU - Montori S AD - Gastrointestinal Endoscopy Research Unit, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain. FAU - Chebaa, Benjamin R AU - Chebaa BR AD - Department of Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA. FAU - Dunbar, Kerry B AU - Dunbar KB AD - Department of Medicine, VA North Texas Healthcare System, Dallas, Texas, USA; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. FAU - Heitman, Steven J AU - Heitman SJ AD - Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. FAU - Feagins, Linda A AU - Feagins LA AD - Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. FAU - Albeniz, Eduardo AU - Albeniz E AD - Gastrointestinal Endoscopy Research Unit, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain; Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain. FAU - Pohl, Heiko AU - Pohl H AD - Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA; Department of Gastroenterology, VA Medical Center, White River Junction, Vermont, USA; Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. FAU - Bourke, Michael J AU - Bourke MJ AD - Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review DEP - 20220603 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM CIN - Gastrointest Endosc. 2022 Nov;96(5):732-734. PMID: 36127161 CIN - Gastrointest Endosc. 2022 Dec;96(6):1094-1095. PMID: 36404094 MH - Humans MH - *Colonic Polyps/pathology MH - *Endoscopic Mucosal Resection/adverse effects MH - Gastrointestinal Hemorrhage/etiology MH - Randomized Controlled Trials as Topic MH - Surgical Instruments EDAT- 2022/06/07 06:00 MHDA- 2022/10/26 06:00 CRDT- 2022/06/06 19:22 PHST- 2022/03/02 00:00 [received] PHST- 2022/04/18 00:00 [revised] PHST- 2022/05/24 00:00 [accepted] PHST- 2022/06/07 06:00 [pubmed] PHST- 2022/10/26 06:00 [medline] PHST- 2022/06/06 19:22 [entrez] AID - S0016-5107(22)01733-3 [pii] AID - 10.1016/j.gie.2022.05.020 [doi] PST - ppublish SO - Gastrointest Endosc. 2022 Nov;96(5):721-731.e2. doi: 10.1016/j.gie.2022.05.020. Epub 2022 Jun 3.