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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
Summary
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.
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.
