Prophylactic Rectal ESD (Endoscopic Submucosal Dissection) Defect Closure and Post-ESD Clinical Outcomes: An...

Prophylactic endoscopic submucosal dissection (ESD) defect closure has been suggested to reduce delayed adverse events (DAE) associated with ESD but the data are limited. We aim to study the effect of prophylactic rectal ESD defect closure on post-ESD outcomes.

An international multicenter retrospective cohort study was performed between 2016 and 2023 involving patients who underwent rectal ESD without intraprocedural perforations and had follow-up data available for at least 2 weeks post-ESD. Delayed adverse events (DAE) defined as bleeding and perforation within 2 weeks of ESD and post-procedure hospitalization or observation rates were compared between the two groups - ESD defects closed (closure group) and ESD defects open (open group).

A total of 385 patients were included. Complete closure of ESD defects was performed in 166 (43%) patients. DAE were observed in 21 (5.5%) patients. On logistic regression analysis, anticoagulant use, NICE3 lesions and incomplete resections had significantly higher rate of DAE. In these high-risk groups, defect closure had a numerically lower rate of DAE without statistical significance. While defect closure did not significantly reduce the rate of overall DAE (p = 0.16), there were no delayed perforations in the closure group compared to 3 (1.3%) in the open group. A significantly lower number of patients were kept for post-ESD overnight hospital observation in the closure group compared to the open group (17% v 37%, p < 0.01).

Prophylactic closure of rectal ESD defects leads to significantly less overnight hospital observation. Anticoagulant use, NICE 3 lesions and incomplete resections had significantly higher DAE within 2 weeks. While defect closure did not significantly reduce the overall DAE, selective prophylactic defect closure in high-risk groups will need to be studied in larger samples.