Effect of prophylactic clip placement following endoscopic mucosal resection of large colorectal lesions on delayed polypectomy bleeding: A meta-analysis

Table 1 Study characteristics

Study	Study design	Country	Endoscopic Resection (n)			Intervention	Age, mean ± SD	Gender (M/F)	Patients (n)	Lesions (n)	Lesion Size in mm, mean ± SD	Pedunculated (n)	Right colon (n)
			CP	EMR	ESD
Shioji et al[20], 2003	RCT	Japan	-----	413	----	Clip	64 ± 9	118/38	156	205	7.8 ± 3.9	67	97
						Non-Clip	63 ± 12	130/37	167	208	7.8 ± 4.1	65	90
Kaltenbach et al[25], 2007	Cohort	United States	-----	125	----	Clip	68 ± 9	100/0	Not reported	49	16.7 ± 7	Excluded	49
						Non-clip				76			0
Dior et al[23], 2012	Cohort	France	------	139	----	Clip	66 (23-90)1	76/62	Not reported	75	Not reported	Not reported	63
						Non-clip				64
Liaquat et al[11], 2012	Cohort	United States	------	472	----	Clip	67.1 ± 10.9	250/213	Not reported	225	31 (20-100)1	Excluded	273
						Non-clip				247
Matsumoto et al[12], 2012	Cohort	Japan	403		----	Clip	63 ± 12	140/135	Not reported	174	27.1 ± 9.6	Excluded	Not reported
						Non-clip				229
Mori et al[18], 2014	RCT	Japan	------	148	----	Clip	Not reported	Not reported	Not reported	73	15.3 ± 2.84	24	9
						Non-clip				75	15.5 ± 2.60	24	10
Tominaga et al[21], 2014	RCT	Japan	------	801	----	Clip	67 (22-88)1	151/60	211	385	7.7 (5-30)1	229	79
						Non-clip	66.6 (15-94)1	148/68	216	416	8.5 (5-35)1	245	114
Dokoshi et al[15], 2015	RCT	Japan	54	234	----	Clip	67.1 ± 82	109/45	Not reported	154	< 10 mm: 98, 10-20 mm: 48, > 20 mm: 8	41	73
						Non-clip	67.8 ± 112	99/35		134	< 10 mm: 86, 10-20mm: 48, > 20 mm: 6
Zhang et al[13], 2015	RCT	China	----	286	62	Clip	67.9 ± 12.6	112/62	174	174	10-20 mm: 111, 20-40 mm: 63	Excluded	22
						Non-clip	64.2 ± 9.8	107/67	174	174	10-20 mm: 107, 20-40 mm: 67		27
Albéniz et al[22], 2016	Cohort	Spain	----	1056	----	Clip	67.9 ± 10.9	770/444	Not reported	281	30.5 ± 11.8	Excluded	Not reported
						Non-clip				775
Matsumoto et al[16], 2016	RCT	Japan	1064	2300	----	Clip	65 (25-87)	534/218	752	1636	< 5 mm: 388, > 5 mm: 1248	1467	823
						Non-clip	66 (25-88)	513/234	747	1728	< 5 mm: 447, > 5 mm: 1281	1595	845
Osada et al[19], 2016	RCT	Japan	----	----	26	Clip	68.8 ± 8.7	9/4	13	13	677.2 ± 3063	Excluded	Not reported
						Non-clip	66.2 ± 10.4	7/6	13	13	790 ± 2203
Harada et al[24], 2017	Cohort	Japan	----	----	211	Clip	70.7 ± 9.2	124/87	Not reported	123	< 30 mm: 65, 30-60 mm: 58, > 60 mm: 2	14	50
						Non-Clip				88	< 30 mm: 23, 30-60 mm: 53, > 60 mm: 12

¹Range;

²Standard error;

³Area in mm². RCT: Randomized controlled trial; CP: Conventional polypectomy; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.

Table 2 Incidence of delayed polypectomy bleeding and perforation following endoscopic resection

Author/Year	Endoscopic resection (n)			Intervention	Polyps	DPB	Perforation
	CP	EMR	ESD
Shioji et al[20], 2003	-----	413	----	Clip	205	2	0
				No clip	208	2	0
Kaltenbach et al[25], 2007	-----	125	-----	Clip	49	0	0
				No clip	76	0	0
Dior et al[23], 2012	------	139	------	Clip	75	0	Not reported
				No clip	64	3	Not reported
Liaquat et al[11], 2012	------	472	-----	Clip	225	4	1
				No clip	247	24	1
Matsumoto et al[12], 2012	403		------	Clip	174	3	Not reported
				No clip	229	14	Not reported
Mori et al[18], 2014	------	148	-------	Clip	73	2	0
				No clip	75	0	0
Tominaga et al[21], 2014	-------	801	-------	Clip	385	4	Not reported
				No clip	416	9	Not reported
Dokoshi et al[15], 2015	54	234	-------	Clip	154	4	0
				No clip	134	3	0
Zhang et al[13], 2015	------	286	62	Clip	174	2	1
				No clip	174	12	1
Albéniz et al[22], 2016	------	1056	------	Clip	281	4	Not reported
				No clip	775	30	Not reported
Matsumoto et al[16], 2016	1064	2300	------	Clip	1636	18	Not reported
				No clip	1728	15	Not reported
Osada et al[19], 2016	------	------	26	Clip	13	0	0
				No clip	13	0	0
Harada et al[24], 2017	------	------	211	Clip	123	3	0
				No clip	88	2	0

CP: Conventional polypectomy; EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.