Prophylactic Clipping Ineffective for Polyps Less Than 20 mm in Size

Analyses of randomized trials indicate that prophylactic clipping of EMR sites ≥20 mm in size in the proximal colon reduces the risk of delayed hemorrhage.

In a multicenter randomized trial at 10 Japanese centers, 1080 patients with 2960 lesions <20 mm in size were randomized to prophylactic clipping or not. About 57% of polyps were <10 mm in size, and clips were used in 22% of lesions randomized to the no-clipping arm. The postpolypectomy bleed rate was 2.7% in the nonclipped group and 2.3% in the clipped group. In the per-protocol analysis, the bleed rate was 3% in the nonclipped group and 2.4% in the clipped group. There were no differences in transfusion between the groups, and no life-threatening bleeding occurred in either group. Median procedure time was 5 minutes shorter in the nonclipped group, and symptoms, such as abdominal bloating, were lower in the nonclipped group (19% vs 26% in the per-protocol analysis). Multivariable analysis found that the only risk factors for delayed bleeding were larger numbers of resected polyps and hypertension.