Prophylactic Clip Closure for Mucosal Defects is Associated with Reduced Adverse Events After Colorectal Endoscopic Submucosal Dissection: A Propensity-Score Matching Analysis

Abstract

Background: Whether prophylactic endoscopic closure after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events remains unclear due to variabilities in lesion characteristics. Therefore, we conducted a retrospective study using propensity-score matching to evaluate the efficacy of prophylactic clip closure in preventing postoperative adverse events after colorectal ESD. Methods: This single-center retrospective cohort study included 219 colorectal neoplasms which were removed by ESD. The patients were allocated into the closure and non-closure groups, which were compared before and after propensity-score matching. Post-ESD adverse events including major and minor bleeding and delayed perforation were compared between the two groups. Results: In the present study, 97 and 122 lesions were allocated to the closure and non-closure groups, respectively, and the propensity-score matching created 61 matched pairs. The rate of adverse events was significantly lower in the closure group than in the non-closure group (8% vs. 28%, P = 0.008). Delayed perforation occurred in two patients in the non-closure group, whereas no patient in the closure group developed delayed perforation. In contrast, there were no significant differences in other postoperative events including the rate of abdominal pain, fever; white blood cell count, and C-reactive protein; and appetite loss between the two groups. Conclusions: The propensity-score matching analysis demonstrated that prophylactic closure was associated with significantly reduced rate of total adverse events after colorectal ESD. When technically feasible, mucosal defect closure after colorectal ESD may be helpful for a favorable postoperative course.

How to track and register adverse events and incidents related to gastrointestinal endoscopy

“…Compared to diagnostic procedures, AE occurred more frequently during or after therapeutic procedures (n=9 (17,3%) vs n=43 (84,6%) respectively). to all endoscopy procedures or anaesthesia in endoscopy (16)(17)(18). These differences in recording (all vs specific endoscopic procedures / retrospective vs prospective / voluntary vs systematic review of medical files / early vs late AE) may lead to a wide variation in reported AE rates, as encountered in the literature (19,20).…”

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

“…In this study, the rate of delayed bleeding was 1.2 %. This is notable given recent studies that have suggested the role of prophylactic defect closure in possibly reducing the rate of delayed post-ESD bleeding [5,9]. Several studies have identified risk factors for delayed bleeding after colorectal ESD.…”

“…The minimal delayed AE rate (1.2 %) after prophylactic closure using TTS sutures ± TTS clips is noteworthy and suggests secure defect closure. Similarly, TTS clip monotherapy for closure of a large mucosal defect after colorectal ESD has demonstrated a delayed bleeding rate of 0-6 % and a delayed perforation rate of 0 % [4,5]. Large prospective studies are needed to confirm the efficacy of TTS sutures in the prevention of post-ESD bleeding.…”

“…The most common adverse events (AEs) related to ESD include perforation and bleeding. Prophylactic closure of large mucosal defects following colorectal ESD has been reported to reduce the incidence of post-procedure AEs [1][2][3][4][5]; however, complete closure of large or irregular mucosal defects with conventional through-the-scope (TTS) clips is technically challenging and oftentimes not possible. Other devices such as over-the-scope (OTS) clips and OTS sutures can also be used for the closure of gastrointestinal mucosal defects; however, they require endoscope removal for device loading, followed by reinsertion to the defect site, which can be technically challenging and time-consuming, particularly for proximally located lesions [6].…”