The efficacy of prophylactic clip closure of mucosal defects after colorectal endoscopic submucosal dissection on delayed bleeding

Abstract

Objective: Although prophylactic clip closure after endoscopic mucosal resection may prevent delayed bleeding, information regarding colorectal endoscopic submucosal dissection (CR-ESD) is lacking. Therefore, this study evaluated the effect of prophylactic clip closure on delayed bleeding rate after CR-ESD. Materials and methods: A total of 614 CR-ESD procedures performed in 561 patients were retrospectively reviewed. The primary outcome, which was delayed bleeding rate, was analyzed between the prophylactic clip closure and non-closure groups. Furthermore, the predictors of delayed bleeding were also evaluated. Results: The patients were divided into the clip closure group (n ¼ 275) and non-closure group (n ¼ 339). Delayed bleeding rate was significantly lower in the closure group than in non-closure group (6 cases [2.2%] vs. 20 cases [5.9%], p ¼ .026). The univariate logistic regression analyses revealed that delayed bleeding was significantly associated with laterally spreading tumor-granular-nodular mixed type (LST-G-Mix; odds ratio [OR], 3.77; 95% confidence interval [CI], 1.70-8.34; p ¼ .001). By contrast, prophylactic clip closure was significantly associated with low delayed bleeding rate (OR, 0.36; 95%CI, 0.14-0.90; p ¼ .029). The multivariate logistic regression analyses revealed LST-G-Mix as a significant independent delayed bleeding predictor (OR, 3.25; 95%CI,; p ¼ .004), whereas, prophylactic clip closure was identified as a significant independent preventive factor of delayed bleeding (OR, 0.39; 95%CI, 0.15-1.00; p ¼ .049). Conclusions: Prophylactic clip closure after CR-ESD is associated with low delayed bleeding rate. LST-G-Mix promotes delayed bleeding, and performing prophylactic clip closure may be advisable.

Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade

“…5). 54,65,[77][78][79][80][81] Several meta-analyses have revealed the effectiveness of endoscopic closure to prevent postpolypectomy DB, [73][74][75] concluding that closure contributes to DB reduction for >20 mm proximal colorectal polyps. The authors considered that a thinner wall and more superficial submucosal arteries in the proximal than distal colon may lead to an increased bleeding risk after polypectomy-induced submucosal vessel coagulation injury.…”

“…76 Several studies have revealed the efficacy of colorectal post-ESD defect closure to reduce the risk of AEs. 54,70,[77][78][79]81 Because most of these studies were retrospective, selection bias cannot be avoided. Two RCTs showed negative results of defect closure to reduce DB, 65,80 whereas a recent meta-analysis clarified the efficiency of defect closure for preventing AEs after colorectal ESD (OR 0.19; 95% CI 0.08-0.49; P = 0.0005).…”

“…Total rates of overall delayed AEs and DB were significantly lower in the closure than nonclosure group (1.7% [13/758] vs. 6.3% [60/950], P < 0.0001 and 1.2% [9/758] vs. 5.5% [52/950], P < 0.0001), whereas no significant differences were observed in DP (1.5% [4/259] vs. 2.8% [8/286], P = 0.39) and in PECS (6.1% [31/507] vs. 5.3% [31/584], P = 0.60) (Table 5). 54,65,77–81 Several meta‐analyses have revealed the effectiveness of endoscopic closure to prevent postpolypectomy DB, 73–75 concluding that closure contributes to DB reduction for >20 mm proximal colorectal polyps. The authors considered that a thinner wall and more superficial submucosal arteries in the proximal than distal colon may lead to an increased bleeding risk after polypectomy‐induced submucosal vessel coagulation injury 76 .…”

“…The authors considered that a thinner wall and more superficial submucosal arteries in the proximal than distal colon may lead to an increased bleeding risk after polypectomy‐induced submucosal vessel coagulation injury 76 . Several studies have revealed the efficacy of colorectal post‐ESD defect closure to reduce the risk of AEs 54,70,77–79,81 . Because most of these studies were retrospective, selection bias cannot be avoided.…”

Endoscopic Ligation with O-Ring Closure for Mucosal Defects after Rectal Endoscopic Submucosal Dissection: A Feasibility Study (with Video)

“…A recent randomized controlled trial (RCT) [18] and several meta-analyses [19][20][21] revealed that prophylactic closure after polypectomy reduces DB in the right side of the colon. Furthermore, several retrospective studies [12,22] and a meta-analysis [23] showed the efficacy of prophylactic closure in preventing DB after colorectal ESD. The need for prophylactic closure may be influenced by the procedural differences between polypectomy and ESD because of the differences in the density and thickness of the vessels in the dissected layer.…”