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Related Experiment Video

Updated: May 1, 2026

Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
03:57

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Prophylactic Clip Closure to Prevent Bleeding After Colorectal Endoscopic Submucosal Dissection: A Cost-Effectiveness

Daryl Ramai1, Abdulrahman Qatomah2,3, Patrick Magahis4

  • 1Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Clinical and Translational Gastroenterology
|April 30, 2026
PubMed
Summary

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This summary is machine-generated.

Prophylactic clip closure after colorectal endoscopic submucosal dissection (ESD) is a cost-effective strategy to reduce delayed bleeding. This approach offers a favorable incremental cost per quality-adjusted life-year (QALY), making it a valuable consideration for patient care.

Area of Science:

  • Gastroenterology
  • Health Economics
  • Surgical Innovation

Background:

  • Endoscopic submucosal dissection (ESD) is effective for large colorectal neoplasms but carries a risk of delayed bleeding.
  • Prophylactic clip closure of post-ESD defects may mitigate bleeding, but its routine use and cost-effectiveness are not well-established.

Purpose of the Study:

  • To evaluate the cost-effectiveness of prophylactic clip closure following colorectal ESD compared to no closure.

Main Methods:

  • A decision-analytic Markov model was utilized.
  • The model incorporated probabilities of delayed bleeding, management pathways, costs, and quality-adjusted life-years (QALYs).
  • Sensitivity analyses (deterministic and probabilistic) were performed, with a willingness-to-pay threshold of $100,000/QALY.
Keywords:
bleedingcost effectivnessendoscopic submucosal dissectionprophylactic clipping

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Main Results:

  • Prophylactic clipping was more effective and more costly, with an incremental cost-effectiveness ratio (ICER) of $88,843/QALY.
  • The incremental cost was $1,102 with a QALY gain of 0.01.
  • Clipping remained cost-effective under various scenarios, favored in 83.8% of simulations at the $100,000/QALY threshold.

Conclusions:

  • Prophylactic clip closure following colorectal ESD is a cost-effective strategy.
  • It has the potential to reduce delayed bleeding at an acceptable incremental cost.
  • Findings are model-dependent and should be interpreted within the defined parameters.