Clopidogrel and Colonoscopic Polypectomy: Continue or Temporarily Interrupt?: Surgical Endoscopy | September 2026

What Did the Study Find?

This meta-analysis included 5 studies and 536 patients undergoing colonoscopic polypectomy while clopidogrel was either continued or temporarily interrupted.

Temporary interruption reduced immediate post-polypectomy bleeding by 56% (RR 0.44).

No significant difference was found in major delayed bleeding.

Minor delayed bleeding was also similar between strategies.

Thromboembolic events did not differ significantly, but event numbers were very small.

Most procedures involved small polyps, frequently removed using cold-snare techniques.

Evidence came from only 3 randomized and 2 observational studies, limiting certainty.

Why Does It Matter?

Managing clopidogrel around polypectomy requires balancing procedural bleeding against potentially serious cardiovascular thrombosis. The findings suggest interruption reduces immediate bleeding, but provide limited reassurance regarding thrombotic safety.

GastroAGI Takeaway

Lower bleeding risk does not mean clopidogrel should routinely be stopped. Management should remain individualized according to thrombotic risk, indication for clopidogrel and planned endoscopic intervention. In patients with recent coronary stenting or other high-risk cardiovascular indications, interruption should generally require cardiology-guided decision-making rather than being driven by this meta-analysis alone.