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

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is useful for en bloc resection of superficial colorectal neoplasms to ensure accurate histologic diagnoses. However, colorectal ESD is associated with a high frequency of adverse events (AEs). We aimed to investigate the effectiveness of prophylactic clip closure (PCC) of mucosal defects for AEs after colorectal ESD. Patients and methods This study included 197 patients with 211 lesions who underwent colorectal ESD between June 2010 and August 2016. Patients who had delayed perforation, delayed bleeding, abdominal pain, or fever were defined as AEs after colorectal ESD. Complete PCC was defined as completely sutured mucosal defect using endoclips following colorectal ESD, whereas incomplete PCC was defined as the mucosal defects that did not enable PCC or were partially sutured. Clinical records were retrospectively reviewed and clinical outcomes evaluated. Results AEs occurred in 29 lesions (13.7 %), including 12 with delayed bleeding, 12 with fever, 2 with abdominal pain, 2 with fever and abdominal pain, and 1 with delayed bleeding and fever. Delayed perforation was not observed in any patient. The frequency of AEs was significantly lower in the group with complete PCC than in the group with incomplete PCC (7.3 % [9/123] vs. 22.7 % [20/88]; P < 0.001). Multivariate analysis revealed that AEs after colorectal ESD were significantly associated with tumor size and submucosal fibrosis. Subgroup analysis among the resected specimen size of < 40 mm revealed that there was no significant difference in AEs between the 2 groups (5.6 % [6/107] vs. 17.8 % [8/45]; P = 0.069). However, the frequency of fever with complete PCC was significantly lower than that with incomplete PCC (2.8 % [3/107] vs. 13.3 % [6/45]; P = 0.020). Conclusions Tumor size and submucosal fibrosis were independent risk factors for AEs after colorectal ESD. PCC may be effective in minimizing AEs after colorectal ESD, especially the frequency of fever.

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Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection

Endoscopy International Open ◽

10.1055/a-0581-8886 ◽

2018 ◽

Vol 06 (05) ◽

pp. E582-E588 ◽

Cited By ~ 9

Author(s):

Hideharu Ogiyama ◽

Shusaku Tsutsui ◽

Yoko Murayama ◽

Shingo Maeda ◽

Shin Satake ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Exact Test ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Student’S T ◽

Closure Group ◽

Clip Closure

Abstract Background and study aims Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large superficial colorectal tumors, but delayed bleeding remains one of the most common complications of colorectal ESD. The aim of the present study was to evaluate the clinical efficacy of prophylactic clip closure of mucosal defects for the prevention of delayed bleeding after colorectal ESD. Patients and methods We enrolled consecutive patients with colorectal lesions between January 2012 and May 2017 in this retrospective study. In the early part of this period, post-ESD mucosal defects were not closed (non-closure group); however, from January 2014, post-ESD mucosal defects were prophylactically closed with clips when possible (closure group). The main outcome measured was delayed bleeding. Variables were analyzed using the chi-squared test, Fisher’s exact test, or Student’s t-test. Results Of 156 lesions analyzed, 61 were in the non-closure group and 95 in the closure group. Overall, delayed bleeding occurred in 5 cases (3.2 %). The delayed bleeding rate was 0 % (0/95) in the closure group and 8.2 % (5/61) in the non-closure group (P = 0.008). The mean procedure time for closure was 10.4 ± 4.6 min (range 3 – 26 min). Conclusions We demonstrated that prophylactic clip closure of mucosal defects might reduce the risk of delayed bleeding after colorectal ESD.

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Mo1108 CAN THE ORBIT SCORE PREDICT DELAYED BLEEDING AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION IN PATIENTS RECEIVING ORAL ANTICOAGULATION THERAPY?

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2018.04.1869 ◽

2018 ◽

Vol 87 (6) ◽

pp. AB399

Author(s):

Shusei Fukunaga ◽

Yasuaki Nagami ◽

Taishi Sakai ◽

Masaki Ominami ◽

Satoshi Sugimori ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Oral Anticoagulation Therapy ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Colorectal Endoscopic Submucosal Dissection

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Effect of anticoagulants on the risk of delayed bleeding after colorectal endoscopic submucosal dissection

Endoscopy International Open ◽

10.1055/a-1244-2097 ◽

2020 ◽

Vol 08 (11) ◽

pp. E1654-E1663

Author(s):

Hideharu Ogiyama ◽

Takuya Inoue ◽

Akira Maekawa ◽

Shunsuke Yoshii ◽

Shinjiro Yamaguchi ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Occurrence Rate ◽

Gastrointestinal Neoplasms ◽

Bleeding Events ◽

Bleeding Rate ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Significant Difference ◽

Colorectal Endoscopic Submucosal Dissection ◽

Bridge Therapy

Abstract Background and study aims In patients receiving antithrombotic therapy, the risks of delayed bleeding after endoscopic procedures for gastrointestinal neoplasms become a major problem. Few reports have shown the effects of delayed bleeding in patients taking anticoagulants after colorectal endoscopic submucosal dissection (ESD). This study aimed to evaluate the delayed bleeding events after colorectal ESD in patients receiving anticoagulant therapy. Patients and methods We retrospectively analyzed 87 patients taking anticoagulants who underwent colorectal ESD from April 2012 to December 2017 at 13 Japanese institutions participating in the Osaka Gut Forum. Among these patients, warfarin users were managed with heparin bridge therapy (HBT), continued use of warfarin, a temporary switch to direct oral anticoagulation (DOAC), or withdrawal of warfarin, and DOAC users were managed with DOAC discontinuation with or without HBT. We investigated the occurrence rate of delayed bleeding and compared the rates between warfarin and DOAC users. Results The delayed bleeding rate was 17.2 % among all patients. The delayed bleeding rate was higher in DOAC users than in warfarin users (23.3 % vs. 11.4 %, P = 0.14), although no statistically significant difference was observed. In DOAC users, the delayed bleeding rates for dabigatran, rivaroxaban, apixaban, and edoxaban users appeared similar (30 %, 18.2 %, 22.2 %, and 25 %, respectively). The onset of delayed bleeding in both warfarin and DOAC users was late, averaging 6.9 and 9.4 days, respectively. Conclusions Among patients taking anticoagulants, the risk of delayed bleeding after colorectal ESD was relatively high and the onset of delayed bleeding was late.

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