Endoscopic Closure After Colorectal ESD: A Literature Review and Meta-Analysis on Its Efficacy in Preventing Adverse...

Endoscopic closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) has been increasingly adopted to prevent adverse events. Various devices and techniques, including conventional clips, clips with various technical tips, clip with line, clip with device, special clips, and suturing devices, have been developed, achieving high rates of complete closure (approximately 95% on average), although procedure times and technical complexity vary considerably. Among 14 eligible comparative studies, including randomized controlled trials and retrospective studies published up to April 2026, a meta-analysis was performed to evaluate the efficacy of complete closure after colorectal ESD in preventing delayed bleeding (DB), delayed perforation (DP), and post-ESD coagulation syndrome (PECS). For DB, pooled analysis demonstrated that complete endoscopic closure was significantly associated with a reduced risk of DB (odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.60-0.97, p = 0.030, I² = 53.6%). In contrast, no significant differences were observed between the closure and non-closure groups for DP (OR: 0.60, 95% CI: 0.23-1.55, p = 0.290, I² = 0.0%) or PECS (OR: 0.94, 95% CI: 0.65-1.38, p = 0.765, I² = 56.6%). In a literature review, reported risk factors for DB include lesion size >50 mm, an ASA score of III or IV, antithrombotic therapy, age ≥75 years, and rectal location. Severe fibrosis and prolonged ESD procedure time have been reported as risk factors for DP, whereas female sex, age ≥70 years, right-sided colon, and lesion size >24 mm have been associated with PECS. Overall, various closure devices and techniques achieve high technical success rates after colorectal ESD. Complete closure appears beneficial for reducing DB, particularly in high-risk patients, whereas its efficacy for preventing DP and PECS remains uncertain. Further studies are warranted.