Prophylactic wound closure after ESD significantly reduces post-ESD bleeding: stratified and meta-regression analyses...

Colorectal endoscopic submucosal dissection (ESD) enables curative resection but carries a risk of delayed bleeding. The efficacy of prophylactic wound closure remains uncertain. We conducted a systematic review and meta-analysis to evaluate closure versus non-closure and identify high-risk subgroups.

Following PRISMA 2020 guidelines, databases were searched to September 2025 for randomized and comparative cohort studies of closure after colorectal ESD. Primary outcome was delayed bleeding; secondary outcomes were perforation and post-ESD coagulation syndrome (PECS). Pooled odds ratios (ORs) were estimated using random-effects models, with subgroup and meta-regression analyses.

Nine studies (n = 2404) were included. Closure significantly reduced delayed bleeding (OR 0.324, 95% CI 0.172-0.611; I² = 0%). Benefit was greater in large lesions (≥ 3 cm: OR 0.293, 95% CI 0.134-0.641) and in studies with higher rectal proportion (≥ 25%: OR 0.306, 95% CI 0.142-0.661). Meta-regression confirmed associations with lesion size (p = 0.0006) and rectal proportion (p = 0.049). Closure did not significantly affect perforation (OR 1.142, 95% CI 0.565-2.309) or PECS (OR 0.723, 95% CI 0.179-2.916).

Prophylactic closure after colorectal ESD reduces delayed bleeding, particularly in large tumors and rectal lesions, but does not alter perforation or PECS risk. Selective closure in high-risk cases may optimize outcomes.