Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis

Abstract

Background and Aim Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large colorectal lesions. However, colorectal ESD is associated with a high frequency of adverse events (AEs), and the efficacy of prophylactic endoscopic closure after ESD for preventing AEs is still controversial. This meta‐analysis was conducted to assess the efficacy of closure on AEs following colorectal ESD. Methods We searched PubMed, Embase, and the Cochrane Library for eligible studies. The chi‐square‐based Q statistics and the I2 test were used to test for heterogeneity. Pooling was conducted using a fixed or random effects model. Results We identified eight eligible studies that compared the effects of closure vs non‐closure with respect to delayed bleeding, delayed perforation, and post‐ESD coagulation syndrome. Compared with non‐closure (5.2%), closure was associated with a lower incidence (0.9%) of delayed bleeding (pooled odd ratios [ORs]:0.19, 95% CI: 0.08–0.49) following ESD. The pooled ORs showed no significant differences in incidence of delayed perforation (pooled OR: 0.22; 95% CI: 0.05–1.03) or post‐ESD coagulation syndrome (pooled OR:0.75; 95% CI: 0.26–2.18) between the closure and non‐closure groups. Conclusion Prophylactic endoscopic closure may reduce the incidence of delayed bleeding following ESD of colorectal lesions. Future studies are needed to further illuminate risk factors and stratify high risk subjects for a cost‐effective preventive strategy.

Orthodontic Rubber Band-Assisted Endoscopic Submucosal Dissection: An Efficient Method for Treating Superficial Colorectal Tumors

“…According to literature, postoperative bleeding and perforation occur in 1.5%-11.9% [ 19 ] and 1.4%-10.4% [ 20 ] of patients, respectively, after colorectal ESD. In our study, the postoperative bleeding rate and perforation rate were both 2.9% in ORB-ESD patients, versus 4.4% and 2.2%, respectively, in conventional ESD patients.…”

Use of a novel dual-action clip for closure of complex endoscopic resection defects

“…In 2020, Liu et al 5 performed a meta-analysis and found that prophylactic endoscopic closure following colorectal ESD may help decrease risk of delayed bleeding compared to nonclosure. The meta-analysis did not identify any difference with respect to delayed perforation, but studies remain limited, and more work is needed to evaluate this.…”

A novel through-the-scope helix tack-and-suture device for mucosal defect closure following colorectal endoscopic submucosal dissection: a multicenter study

“…Subsequently, tension is placed on the suture to minimize the slack between the tacks before deploying the second tack from the push catheter. Using the same mechanism, the third and fourth tacks are then deployed; this is followed by the deployment of a suture cinch to fix the tacks and approximate the margins of the defect (Supplementary Video 1, Figure 1 and Supplementary figure 3) [9]. Suture patterns are described in Supplementary Figure 4.…”