Combined prophylactic vessel coagulation and high-density complete defect closure after colorectal endoscopic...

The optimal strategy to prevent delayed bleeding after colorectal endoscopic submucosal dissection (ESD) remains unsettled, particularly for large defects with exposed submucosal vessels and an intact muscular layer. We evaluated whether combining prophylactic vessel coagulation with high-density complete defect closure improve safety outcomes.

We analyzed consecutive colorectal ESDs performed over forty-four months at two tertiary referral centers. Prophylactic vessel coagulation plus complete defect closure (using standard clips or advanced closure devices, including Mantis and X-tack systems) was compared with cases receiving coagulation alone. Groups were matched 1:1 using propensity score matching analysis based on age, ASA score, antithrombotic, defect size and location. Cases with intraprocedural perforation, incomplete closure, or use of hemostatic gels or powders were excluded. The primary outcome was delayed bleeding. Secondary outcomes included composite delayed adverse events (DAEs), including bleeding, perforation and PECS, and hospital readmission.

Eighty-seven matched pairs were analyzed with comparable baseline characteristics. The combined strategy significantly reduced delayed bleeding (0% vs 6.9%; p < 0.05) and composite DAEs (3.5% vs 12.7%; p < 0.05). Rates of delayed perforation (0% vs 2.3%) and PECS (3.5% vs 3.5%) were similar (p = n.s.). All bleeding and PECS events were managed endoscopically or conservatively, whereas delayed perforations required surgery. Hospital readmissions were significantly lower in the closure group (4.6% vs 16.1%; p < 0.05), with shorter mean hospital stays.

Combining prophylactic vessel coagulation with high-density complete defect closure after colorectal ESD significantly reduces delayed bleeding, composite DAEs, and unplanned readmissions, supporting its role as an effective strategy to enhance post-ESD safety.