Ability of prophylactic clipping to reduce the incidence of delayed bleeding in patients undergoing endoscopic resection of colonic polyps: a rapid evidence assessment review

Background:
Delayed bleeding is a recognised complication following colonic endoscopic resection.

Prophylactic clip application is often used to reduce this. However, there is a lack of guidelines to support this.

Aims:
This article aims to review the most recent evidence on the question: 'In patients undergoing endoscopic resection of colonic polyps, does prophylactic clipping of the resection, compared with not clipping, reduce the incidence of delayed bleeding?'.

Methods:
A rapid assessment was undertaken regarding prophylactic clipping efficacy to reduce delayed bleeding. A search of three databases (Medline, the University of Derby Library Plus and the Cochrane Library) was undertaken to identify articles from the past 4 years.

Findings:
Eight publications were reviewed: three meta-analyses and five randomised control trials. Five publications recommended against prophylactic clipping following colonic endoscopic resection and three, the most recent publications, strongly recommended it, specifically for those at high risk of delayed bleeding.

Conclusion:
Prophylactic clip application to reduce delayed bleeding is not effective across all colonic resections. However, there is evidence in favour of clipping for patients with high risk of delayed bleeding.