Post written by Louis H.S. Lau, MBChB, and Francis K. L. Chan, MD, from the Department of Medicine and Therapeutics, Faculty of Medicine, and the Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong SAR.

This study focused on examining the benefit of prophylactic clipping after colonoscopic polypectomy or endoscopic resection in high-risk patients using aspirin.

After endoscopic resection during a colonoscopy, delayed bleeding is a common adverse event, especially among high-risk patients using antithrombotics including aspirin. To reduce this risk, endoscopists often apply endoclips prophylactically. The clinical efficacy and economical cost-effectiveness of this practice remain questionable in this patient subgroup because of the limited evidence available.

Our recent publication shows that prophylactic clipping was not associated with a reduced risk of postpolypectomy bleeding in oral anticoagulant users. Therefore, we performed another propensity-score analysis to evaluate the effectiveness of prophylactic clipping among aspirin users to bridge the knowledge gap.

A total of 1373 patients with 3952 polyps were included in the analysis. We found that prophylactic clipping was not associated with a reduced risk of 30-day delayed postpolypectomy bleeding among aspirin users in main analysis (per patient and per polyp) and subgroup analysis (polyps larger than 20 mm or right-sided). Based on our findings, we recommend against the routine use of prophylactic clipping in aspirin users without other risk factors.

A large prospective, randomized, controlled trial is necessary to validate the current findings of prophylactic clipping after colonoscopic polypectomy in aspirin users.

(A) Per-patient and (B) per-polyp subgroup analysis to assess the effect of prophylactic clipping on postpolypectomy bleeding. The variable polypectomy mode was in reference to the largest polyp. ESD, Endoscopic submucosal dissection; OR, odds ratio; CI, confidence interval; NA, not available.

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