Temporary interruption versus continuation of clopidogrel in patients undergoing colonoscopy with polypectomy: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Colonoscopy with polypectomy is effective for colorectal cancer prevention, but post-polypectomy bleeding (PPB) is one of the most common adverse events. In patients receiving clopidogrel, clinical decisions regarding temporary interruption versus continuation before polypectomy remain controversial, with uncertain effects on bleeding and cardioembolic outcomes. We conducted a systematic review and meta-analysis to compare the safety of both strategies. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library through September 2025 for randomized controlled trials (RCTs) and observational studies comparing temporary interruption versus continuation of clopidogrel in adults undergoing colonoscopy with polypectomy. Primary outcomes were immediate PPB, major delayed PPB, and minor delayed PPB. The secondary outcome was cardioembolic events. We used a random-effects model to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). RESULTS: Five studies (536 patients) were included. The temporary interruption of clopidogrel significantly reduced the risk of immediate PPB compared with continuation (RR 0.44; 95% CI 0.20-0.96). No significant differences were observed for major delayed PPB (RR 0.30; 95% CI 0.04-2.22), minor delayed PPB (RR 1.45; 95% CI 0.25-8.42), and cardioembolic events (RR 1.24; 95% CI 0.34-4.53) between the groups. CONCLUSION: Temporary interruption of clopidogrel before colonoscopy with small-polyp polypectomy, most commonly using cold snare techniques, reduced the risk of immediate PPB without significantly increasing delayed bleeding and cardioembolic events. However, additional large-scale RCTs are needed to confirm these findings and guide optimal periprocedural management.