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Combined prophylactic vessel coagulation and high-density complete defect closure after colorectal endoscopic
Roberto de Sire1, Vincenzo Vadalà2, Francesco Minini2
1Endoscopy Unit, Gastroenterology Department, Humanitas Research Hospital IRCCS, Rozzano, Italy; Endoscopy Unit, Gastroenterology Department, Humanitas San Pio X Hospital, Milan, Italy.
Gastrointestinal Endoscopy
|July 24, 2026
Summary
Combining vessel coagulation with complete defect closure significantly reduces delayed bleeding after colorectal endoscopic submucosal dissection (ESD). This enhanced strategy also lowers adverse events and hospital readmissions, improving patient safety.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Colorectal Surgery
Background:
- Optimal prevention of delayed bleeding after colorectal endoscopic submucosal dissection (ESD) is unclear, especially for large defects.
- Exposed submucosal vessels and intact muscular layers pose challenges in preventing post-ESD bleeding.
Purpose of the Study:
- To evaluate if combining prophylactic vessel coagulation with high-density complete defect closure improves safety outcomes after colorectal ESD.
- To assess the efficacy of this combined strategy in reducing delayed bleeding and other adverse events.
Main Methods:
- A comparative analysis of consecutive colorectal ESDs over 44 months at two centers.
- Propensity score matching (1:1) compared prophylactic vessel coagulation plus complete defect closure versus coagulation alone.
- Exclusion criteria included intraprocedural perforation, incomplete closure, or use of hemostatic adjuncts.
Main Results:
- The combined strategy significantly reduced delayed bleeding (0% vs. 6.9%) and composite delayed adverse events (DAEs) (3.5% vs. 12.7%).
- Delayed perforation and post-ESD complications (PECS) rates were similar between groups.
- Hospital readmissions were significantly lower (4.6% vs. 16.1%) with shorter hospital stays in the combined closure group.
Conclusions:
- Combining prophylactic vessel coagulation with high-density complete defect closure is an effective strategy to enhance post-ESD safety.
- This approach significantly reduces delayed bleeding, composite DAEs, and unplanned readmissions.
- The findings support the adoption of this combined technique for improved patient outcomes.
