A meta-analysis and systematic review of prophylactic endoscopic treatments for postpolypectomy bleeding

Li, Long-yuan; Liu, QS; Li, L; Cao, Ye; Yuan, Qiuzhen; Liang, SW; Qu, CM

doi:10.1007/s00384-011-1141-8

Cited by 34 publications

(27 citation statements)

References 34 publications

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“…Prophylactic epinephrine use has had mixed results in the prevention of postpolypectomy bleeding, refl ecting heterogeneity in study design, concomitant use of other prophylactic modalities, and lesion and patient characteristics (19)(20)(21)(22)(23). Th e use of epinephrine in the injection solution has not been specifi cally assessed prospectively in the WF-EMR setting.…”

Section: Discussionmentioning

confidence: 95%

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Bahin

Rasouli

Byth

et al. 2016

American Journal of Gastroenterology

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Section: Discussionmentioning

confidence: 95%

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Bahin

Rasouli

Byth

et al. 2016

American Journal of Gastroenterology

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“…The second meta-analysis evaluated the impact of endoscopic prophylactic methods on early PPB (within the first 24 h). 96 Diluted adrenaline injection reduced significantly the risk of early PPB (OR, 0.37; 95% CI 0.22 to 0.64) as well as any other single prophylactic modality. No significant difference was observed between endoclip and detachable snare in a recent multicentre RCT to prevent delayed PPB in patients with pedunculated polyps with a large stalk (≥10 mm) (5.1% vs 5.7%, respectively).…”

Section: Post Polypectomy Bleedingmentioning

confidence: 94%

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Vanbiervliet²,

et al. 2017

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“…28 In the original papers, the primary end point was typically all PPH. As early bleeding, like delayed bleeding, requires assessment, investigation, and possibly transfusion and therapy, we combined these end points for our analysis.…”

Section: Discussionmentioning

confidence: 99%

“…One meta-analysis examined the use of prophylactic haemostatic measures in preventing PPH, 28 but included smaller polyps (<10 mm) which are less likely to bleed. 17,18 The frequency with which smaller polyps are removed may make widespread adoption of prophylactic haemostatic measures untenable from a cost-benefit perspective and the time taken during endoscopy.…”

Section: Introductionmentioning

confidence: 99%

Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta‐analysis

et al. 2014

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Background and aim: Postpolypectomy haemorrhage (PPH) is a known adverse event that can occur following polypectomy, occurring in 0.3-6.1% of cases. Previous meta-analysis has included small polyps, which are less likely to bleed, and less amenable to some methods of mechanical haemostasis. No comprehensive cost-benefit analysis of this topic is available. The aim of this study was to perform a meta-analysis of randomized trials and a cost-benefit analysis of prophylactic haemostasis in PPH. Methods: A total of 3092 abstracts from prospective trials conducted in human colonoscopic polypectomy were screened. Outpatients undergoing polypectomy in seven suitable studies (1426 episodes), without polyposis syndromes or bleeding diathesis, were identified. The interventions of prophylactic haemostatic measures (clips, loops, and/or adrenaline injection) to prevent PPH were assessed. The main outcome measurements were PPH measured by haematochezia or drop in haematocrit >10% or haemoglobin >1 g/dl. Risk ratio and number needed to treat (NNT) were generated using metaanalysis. Results: Comparing any prophylactic haemostasis to none, the pooled risk ratio for PPH was 0.35 (0.21-0.57; p < 0.0001), NNT was 13.6, and cost to prevent one PPH was USD652. Using adrenaline alone vs. no prophylactic haemostasis revealed a pooled risk ratio of 0.37 (0.20-0.66; p ¼ 0.001), NNT 14.0, cost to prevent one PPH USD382. Any prophylactic mechanical haemostasis compared to adrenaline produced a RR for PPH of 0.28 (0.14-0.57; p < 0.0001), NNT 12.3, and cost to prevent one PPH USD1368. Conclusions: Adrenaline injection or mechanical haemostasis reduces the risk of PPH. Routine prophylactic measures to reduce PPH for polyps larger than 10 mm are potentially cost effective, although more thorough cost-benefit modelling is required.

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A meta-analysis and systematic review of prophylactic endoscopic treatments for postpolypectomy bleeding

Abstract: Prophylactic endoscopic treatments are effective at reducing early PPB after colonoscopic polypectomy. However, patients with late PPB may not benefit from bleeding prophylaxis.

Cited by 34 publications

References 34 publications

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

Postpolypectomy haemorrhage following removal of large polyps using mechanical haemostasis or epinephrine: a meta‐analysis

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