Clips prevent postoperative complications of gastrointestinal endoscopy: a Meta-analysis

doi:10.3877/cma.j.issn.2095-2015.2018.04.004

Abstract

Abstract:

Objective

To assess the effectiveness of using Clip closure of defect after endoscopic mucosal resection(EMR), endoscopic submucosal dissection(ESD)and others to reduce the rate of delayed postoperative bleeding and accelerate wound healing.

Methods

Papers published before October 2017 in PubMed、EMBase and Cochrance library about using Clip closure of defect after EMR, ESD were obtained by computer retrieval.Meta-analysis for each outcome of the included studies that were identified by the inclusion criteria and the exclusion criteria was conducted using software Review Manager 5.3.

Results

Finally a total of six randomized controlled trial studies were included.Meta-analysis showed that Clip closure of defect after endoscopic surgery did not reduce the incidence of delayed postoperative bleeding(OR=0.43, 95% CI: 0.14-1.29, P=0.13), and there was no statistically significant difference.But using Clip closure of defect after endoscopic surgery could accelerate wound healing(OR=-1.18, 95% CI: -1.77~-0.60, P<0.01), and the difference was statistically significant.

Conclusion

Using Clip closure of defect after EMR, ESD and others can not reduce the rate of delayed postoperative bleeding but may be able to accelerate wound healing.

Key words: Clip, Endoscopic mucosal resection, Endoscopic submucosal dissection, Delayed postoperative bleeding, Meta-analysis

Mingliang Yuan, Wansheng Ji, Jingwu Dong, Xuechun Yu, Ling Fu, Yongqi Zhang, Zhixing Gao. Clips prevent postoperative complications of gastrointestinal endoscopy: a Meta-analysis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2018, 08(04): 158-162.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2018.04.004

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2018/V08/I04/158

Figures/Tables 5

References 22

1	Gotoda T, Kaltenbach T, Soetikno R, et al.Is en bloc resection essential for endoscopic resection of GI neopasia？[J]. Gastrointest Eudosc, 2008, 67(6): 805-807.
2	Park YM, Cho E, Kang HY, et al.The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and meta-analysis[J]. Surg Endose, 2011, 25(8): 2666-2677.
3	Ono H, Kondo H, Gotoda T, et al.Endoscopic mucosal resection for treatment of early gastric cancer[J]. Gut, 2001, 48(2): 225-229.
4	Saito Y, Uraoka T, Yamaguchi Y, et al.A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections(with video)[J]. Gastrointest Endosc, 2010, 72(6): 1217-1225.
5	Saito Y, Fukuzawa M, Matsuda T, et al.Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection[J]. Surg Endosc, 2010, 24(2): 343-352.
6	Kobayashi N, Yoshitake N, Hirahara Y, et al.Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors[J]. J Gastroenterol Hepatol, 2012, 27(4): 728-733.
7	Cao Y, Liao C, Tan A, et al.Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract[J]. Endoscopy, 2009, 41(9): 751-757.
8	Goto O, Fujishiro M, Oda I, et al.A multicenter survey of the management after gastric endoscopic submucosal dissection related to postoperative bleeding[J]. Dig Dis Sci, 2012, 57(2): 435-439.
9	Nakajima T, Saito Y, Tanaka S, et al.Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan[J]. Surg Endosc, 2013, 27(9): 3262-3270.
10	Choi KD, Jung HY, Lee GH, et al.Application of metal hemoclips for closure of endoscopic mucosal resection-induced ulcers of the stomach to prevent delayed bleeding[J]. Surg Endosc, 2008, 22(8): 1882-1886.
11	Feagins LA, Nguyen AD, Iqbal R, et al.The prophylactic placement of hemoclips to prevent delayed post-polypectomy bleeding: An unnecessary practice? A case control study[J]. Dig Dis Sci, 2014, 59(4): 823-828.
12	Shioji K, Suzuki Y, Kobayashi M, et al.Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy[J]. Gastrointest Endosc, 2003, 57(6): 691-694.
13	Lee BI, Kim BW, Kim HK, et al.Routine mucosal closure with a detachable snare and clips after endoscopic submucosal dissection for gastric epithelial neoplasms: a randomized controlled trial[J]. Gut Liver, 2011, 5(4): 454-459.
14	Qi-Sheng Zhang, Bing Han, Jian-Hua Xu, et al.Clip closure of defect after endoscopic resection in patients with larger colorectal tumors decreased the adverse events[J]. Gastrointest Endosc, 2015, 82(5): 904-909.
15	Ritsuno H, Osada T, Sakamoto N, et al.Suturing of areas of mucosal defects using endoscopic clips accelerated wound healing after colorectal endoscopic submucosal dissection[J]. Gastroenterology, 2015, 148(4): S787-S788.
16	Osada T, Sakamoto N, et al.Closure with clips to accelerate healing of mucosal defects caused by colorectal endoscopic submucosal dissection[J]. Surg Endosc, 2016, 30(10): 4438-4444.
17	Mio Matsumoto, Mototsugu Kato, Koji Oba, et al.Multicenter randomized controlled study to assess the effect of prophylactic clipping on post-polypectomy delayed bleeding[J]. Dig Endosc, 2016, 28(5): 570-576.
18	Liaquat H, Rohn E, Rex DK.Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions[J]. Gastrointest Endosc, 2013；77(3): 401-407.
19	Fujihara S, Mori H, Kobara H, et al.The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection[J]. Oncol Rep, 2013, 30(1): 85-90.
20	Mori H, Kobara H, Nishiyama N. Simple and reliable treatment for post-EMR artificial ulcer floor with snare cauterization for 10-to 20-mm colorectal polyps: a randomized prospective study(with video)[J]. Surg Endosc, 2015, 29(9): 2818-2824.
21	Uedo N, Takeuchi Y, Yamada T, et al.Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial[J]. Am J Gastroenterol, 2007, 102: 1610-1616.
22	Oh TH, Jung HY, Choi KD, et al.Degree of healing and healingassociated factors of endoscopic submucosal dissection-induced ulcers after pantoprazole therapy for 4 weeks[J]. Dig Dis Sci, 2009, 54(7): 1494-1499.

研究	国家	部位	性别(男∶女)	年龄	手术类型	创面大小	分组	例数	延迟性出血	穿孔	腹痛	电凝综合征	住院天数	4周后创面面积
Shioji等^[12]	日本	结直肠	118∶38	64±9	EMR	(12.3±4.6) mm²	试验组	205	2	NR	NR	NR	?	NR
Shioji等^[12]	日本	结直肠	130∶37	63±12	?	(12.3±4.9)mm²	对照组	208	2	?	?	?	?	?
Lee等^[13]	韩国	胃	18∶8	63.2±7.8	ESD	(4.5～37.7 ) cm²	试验组	26	0	NR	NR	NR	2－4	NR
Lee等^[13]	韩国	胃	19∶7	63.9±6.8	?	(5.9～30.0 )cm²	对照组	26	1	?	?	?	3－13	?
Zhang等^[14]	中国	结直肠	112∶62	67.9	EMR、ESD、	1～4 cm	试验组	174	2	1	5	1	3.1±0.3	NR
Zhang等^[14]	中国	结直肠	107∶67	64.2	CEMR	?	对照组	174	12	1	29	8	4.7±0.4	?
Ritsuno等^[15]	日本	结直肠	NR	NR	ESD	(670±220) mm²	试验组	14	0	0	NR	NR	NR	4.3±8.16 mm²
Ritsuno等^[15]	日本	结直肠	?	?	?	(790±312.7)mm²	对照组	14	0	0	?	?	?	48.5±56.7mm²
Osada等^[16]	日本	结直肠	4∶9	68.8±8.7	ESD	(677.2±306.3) mm²	试验组	13	0	0	NR	NR	NR	2.17±4.51 mm²
Osada等^[16]	日本	结直肠	7∶6	66.2±10.4	?	(790.0±220.6)mm²	对照组	13	0	0	?	?	?	27.42±25.72mm²
Matsumoto等^[17]	日本	结直肠	534∶218	65	EMR	<2 cm	试验组	1 636	18	NR	NR	NR	NR	NR
Matsumoto等^[17]	日本	结直肠	513∶234	66	?	?	对照组	1 729	15	?	?	?	?	?

研究	国家	部位	性别(男∶女)	年龄	手术类型	创面大小	分组	例数	延迟性出血	穿孔	腹痛	电凝综合征	住院天数	4周后创面面积
Shioji等^[12]	日本	结直肠	118∶38	64±9	EMR	(12.3±4.6) mm²	试验组	205	2	NR	NR	NR	?	NR
Shioji等^[12]	日本	结直肠	130∶37	63±12	?	(12.3±4.9)mm²	对照组	208	2	?	?	?	?	?
Lee等^[13]	韩国	胃	18∶8	63.2±7.8	ESD	(4.5～37.7 ) cm²	试验组	26	0	NR	NR	NR	2－4	NR
Lee等^[13]	韩国	胃	19∶7	63.9±6.8	?	(5.9～30.0 )cm²	对照组	26	1	?	?	?	3－13	?
Zhang等^[14]	中国	结直肠	112∶62	67.9	EMR、ESD、	1～4 cm	试验组	174	2	1	5	1	3.1±0.3	NR
Zhang等^[14]	中国	结直肠	107∶67	64.2	CEMR	?	对照组	174	12	1	29	8	4.7±0.4	?
Ritsuno等^[15]	日本	结直肠	NR	NR	ESD	(670±220) mm²	试验组	14	0	0	NR	NR	NR	4.3±8.16 mm²
Ritsuno等^[15]	日本	结直肠	?	?	?	(790±312.7)mm²	对照组	14	0	0	?	?	?	48.5±56.7mm²
Osada等^[16]	日本	结直肠	4∶9	68.8±8.7	ESD	(677.2±306.3) mm²	试验组	13	0	0	NR	NR	NR	2.17±4.51 mm²
Osada等^[16]	日本	结直肠	7∶6	66.2±10.4	?	(790.0±220.6)mm²	对照组	13	0	0	?	?	?	27.42±25.72mm²
Matsumoto等^[17]	日本	结直肠	534∶218	65	EMR	<2 cm	试验组	1 636	18	NR	NR	NR	NR	NR
Matsumoto等^[17]	日本	结直肠	513∶234	66	?	?	对照组	1 729	15	?	?	?	?	?

文献	随机序列的产生	随机化隐藏	盲法	撤出与退出	总分
Shioji等^[12]	1	2	0	1	4
Lee等^[13]	1	1	0	1	3
Zhang等^[14]	1	2	1	1	5
Ritsuno等^[15]	1	2	0	1	4
Osada等^[16]	1	2	0	1	4
Matsumoto等^[17]	2	2	0	1	5

文献	随机序列的产生	随机化隐藏	盲法	撤出与退出	总分
Shioji等^[12]	1	2	0	1	4
Lee等^[13]	1	1	0	1	3
Zhang等^[14]	1	2	1	1	5
Ritsuno等^[15]	1	2	0	1	4
Osada等^[16]	1	2	0	1	4
Matsumoto等^[17]	2	2	0	1	5

[1]	Siping Zhang, Wei Liu, Pengcheng Ma. Therapeutic effects of lower extremity mild varus alignment after total knee arthroplasty [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 808-817.
[2]	Wanglin Luo, Chuanjun Yang, Guoxing Xu, Jianguo Yu, Weidong Sun, Wenjuan Yan, Zhi Feng. Meta analysis on implantation of different grafting materials in open wedge high tibial osteotomy [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(06): 818-826.
[3]	Hongxing Chen, Lijun Zhang, Yong Zhang, Hu Li, Chi Zhou, Yinuo Fan. Meta-analysis of effect of external application of traditional Chinese medicine after arthroscopic debridement in knee osteoarthritis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(05): 663-672.
[4]	Wei Yang, Xia Hao, Dongzhen Zhu, Jinbo Zhang, Xuefei Tian, Bin Yao. A meta analysis of the clinical effect of traditional Chinese medicine on burn and scald patients [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(05): 419-426.
[5]	Xiongxiong Li, Chan Zhou, Ting Xu, Yu Ren, Jin Shang. Metastasis rate of newly diagnosed ductal carcinoma in situ with microinvasive axillary lymph nodes: A Meta-analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 466-474.
[6]	Zaibo Zhang, Bingyu Wang, Zhikai Jiao, Bibo Tan. Risk factors for lower extremity deep venous thrombosis after gastric cancer surgery: A Meta-analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 475-480.
[7]	Huiming Wu, Renkai Guo, Huiyu Li. Safety and efficacy of robot-assisted natural orifice specimen extraction surgery for colorectal cancer: A meta-analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 395-400.
[8]	Chengxue Yuan, Zongxia Zhang, Ting Xu, Slanglam. Effect and safety of three kinds of endoscopic surgeries on colon polyps [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 78-81.
[9]	Xian Mo, Chuang Yang. Meta-analysis of risk factors for portal vein thrombosis in patients with cirrhosis [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 678-683.
[10]	Wenzhong Duan, Yanxia Bai, Wenting Xu, Hongxia Qi, Zhijian Lyu. Anesthetic effects of sevoflurane and propofol in hepatectomy: a Meta-analysis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 640-645.
[11]	Hailong Yang, Manjun Deng, Yichen Fan, Mengyu Xu, Fangde Chen, Weihao Wu, Shengyuan Zhang. Risk factors of bile leakage after primary suture of laparoscopic common bile duct exploration: a Meta-analysis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(05): 545-550.
[12]	Hongli Xu, Yulin Yang, Qing Xue, Qian Zhang, Lihong Ma, Zhengang Qiu. Efficacy of extracorporeal shock wave for non-specific low back pain: a systematic review and Meta-analysis [J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(05): 307-314.
[13]	Chao Hou, Meichen Pan, Wenming Wu, Xingguang Huang, Xiang Li, Lingxue Cheng, Yuxuan Zhu, Wenbo Li. Risk factors of esophageal stricture after endoscopic submucosal dissection for early esophageal carcinoma and intraepithelial neoplasia [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 383-387.
[14]	Zhengying Zhang, Yang Ju, Xiaoning Liu. Effect of oral metformin on postoperative recurrence of type 2 diabetes mellitus with colorectal adenoma [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 485-488.
[15]	Xiu Wang, Yiguo Wang. Efficacy and safety of ustekinumab in treating perianal fistulizing Crohn′s disease: a meta-analysis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 514-519.

Please choose a citation manager

Content to export