Efficacy of prophylactic hemoclip placement for preventing delayed post-polypectomy bleeding in nonpedunculated colorectal lesions: updated meta-analysis and trial sequential analysis of randomized controlled trials

Background and Aims: Evidence regarding prophylactic hemoclip (HC) for preventing delayed post-polypectomy bleeding (DPPB) remains inconsistent. This meta-analysis with trial sequential analysis (TSA) aimed to evaluate HC after thermal resection of nonpedunculated colorectal polyps. Methods: MEDLINE, Embase, and the Cochrane Library were searched through 28 July 2026 for randomized controlled trials (RCTs) comparing HC with non-HC after thermal resection of nonpedunculated colorectal polyps ≥ 5 mm. The primary outcome was DPPB. Secondary outcomes included DPPB for proximal large (≥ 20 mm) nonpedunculated colorectal polyps (LNPCPs), other adverse events, and procedure time. Random-effects models, subgroup analyses, GRADE, and TSA were applied. Results: Ten RCTs involving 4,588 patients were included. HC reduced DPPB overall (3.4 vs. 6.5%; RR 0.51; 95% CI 0.34–0.76; P < 0.001; I2 = 45%; GRADE: High) and after resection of proximal LNPCPs (4.4 vs. 8.1%; RR 0.54; 95% CI 0.32–0.91; P = 0.02; I2 = 52%; GRADE: moderate). TSA supported both findings. Patients receiving antithrombotic therapy may experience greater absolute risk reduction because of higher baseline bleeding risk. HC was also associated with reduced DPPB in adenomatous lesions; however, interaction tests were nonsignificant, and subgroup findings remain exploratory. Other outcomes did not differ significantly. Conclusions: Prophylactic HC closure reduces DPPB after thermal resection of nonpedunculated colorectal polyps ≥ 5 mm, including proximal LNPCPs. Clinical use should consider lesion characteristics, procedural factors, and individualized bleeding risk.