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Effect of Prophylactic Colon ESD (Endoscopic Submucosal Dissection) Defect Closure on Post-ESD Outcomes: An

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|November 5, 2025
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Closing defects after colonic endoscopic submucosal dissection (ESD) significantly reduces delayed bleeding and overnight hospital stays. This prophylactic closure is especially beneficial for right-sided polyps, improving patient outcomes and potentially enabling same-day discharge.

Keywords:
BleedingColonDefect closuresDelayed adverse eventsEndoscopic submucosal dissectionPerforation

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Medical Device Technology

Background:

  • Endoscopic submucosal dissection (ESD) for colonic lesions can lead to delayed adverse events (DAEs) like bleeding and perforation.
  • Prophylactic closure of ESD defects may mitigate these risks and facilitate same-day discharge.

Purpose of the Study:

  • To compare the incidence of DAEs and overnight hospital admission between closed and open colonic ESD defects.
  • To evaluate the efficacy of prophylactic defect closure in reducing post-ESD complications.

Main Methods:

  • A Western multicenter retrospective study involving patients who underwent colonic ESD (excluding rectal lesions).
  • Comparison of DAEs and overnight hospital admission between a group with complete defect closure and a group without closure.
  • Multivariate analyses were conducted to identify risk factors and protective measures.

Main Results:

  • Complete defect closure was achieved in 71.8% of 560 patients.
  • The closed group showed a significantly lower rate of delayed bleeding (1.7% vs. 5.6%, p=0.03).
  • Defect closure reduced the risk of delayed bleeding (aOR=0.2), especially for right-sided polyps (NNT=12.5).
  • Malignant polyps increased the risk of perforation and hospitalization.
  • Defect closure (aOR=0.6) also significantly reduced the risk of overnight hospitalization.

Conclusions:

  • Prophylactic closure of colonic ESD defects significantly reduces delayed bleeding (NNT=25.6) and post-procedural overnight hospitalization.
  • Closure is particularly effective for right-sided polyps.
  • Prospective studies are recommended to validate these findings.