Prophylactic Clipping Ineffective for Polyps Less Than 20 mm in Size

Prophylactic Clipping Ineffective for Polyps Less Than 20 mm in Size

Douglas K. Rex, MD, FASGE, reviewing Inoue T, et al. J Gastroenterol Hepatol 2020 Jun 8.

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.

Douglas K. Rex, MD, FASGE


Overall these results favor not routinely clipping EMR defects after electrocauterization of lesions <20 mm in size. There are still unanswered questions as to whether clipping might be beneficial in patients resuming high-risk antiplatelet agents and anticoagulants. It’s interesting that hypertension, which has been seen as a risk factor for postpolypectomy bleeding in some but not all previous studies, appeared as a risk factor here in both the intention-to-treat and per-protocol analyses.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Inoue T, Ishihara R, Nishida T, et al. Prophylactic clipping is not effective in preventing post-polypectomy bleeding for <20-mm colon polyps: a multicenter open-label randomized controlled trial. J Gastroenterol Hepatol 2020 Jun 8. (Epub ahead of print) (

Related Posts

Scroll to Top