Effect of Prophylactic Colon ESD (Endoscopic Submucosal Dissection) Defect Closure on Post-ESD Outcomes: An International Multi-center Retrospective Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: Prophylactic colonic endoscopic submucosal dissection (ESD) defect closure may reduce delayed adverse events (DAEs) such as bleeding and perforation associated with ESD and facilitate same day discharge. We compared the effect of colonic ESD defect closure (closed group) with no closure (open group) on DAEs and overnight hospital admission. METHODS: We performed a Western multicenter retrospective study on patients who underwent colon ESD. Rectal lesions were excluded. DAEs were defined as adverse events within 2 weeks of ESD. Primary outcome measures were DAEs and overnight hospital admission. Multivariate analyses were performed. RESULTS: 560 patients underwent colon ESD and 364 (71.8%) patients had complete defect closure. Closed group had a significantly lower rate of delayed bleeding (1.7% vs 5.6%, p = 0.03) compared to open group. Multivariate analysis with adjusted odds ratios (aOR) revealed right sided polyps (aOR = 7.0) and anticoagulation/antiplatelet agents (aOR = 6.6) increased the risk while defect closure (aOR = 0.2) decreased the risk of delayed bleeding. Defect closure amplified the reduction in risk of delayed bleeding (2.4% vs 10.4%, p = 0.014) for right-sided polyps. Malignant polyps significantly increased the risk of delayed perforation (aOR = 3.3) and overnight hospitalization (aOR = 2.9). Defect closure (aOR = 0.6), traction use (aOR = 0.6) and topical hemostatic agent use (aOR = 0.4) significantly reduced the risk of overnight hospitalization. CONCLUSION: Prophylactic closure of colon ESD defects was associated with a significant reduction in delayed bleeding with number needed to treat (NNT) of 25.6 (especially for right sided polyps, NNT 12.5), and post-procedural overnight hospitalization. Prospective studies are needed to further validate these results.
Source: Digestive Diseases and Sciences
Authors: Rahul Karna, Jonathan Colón Sánchez, Kevan Josloff, Tammy Tran, Kasenee Tiankanon, Saowanee Ngamruengphong, Elisabet Maristany Bosch, Georgios Kalopitas, Edward John Despott, Alberto Murino, Shaimaa Elkholy, Mohamed El Sherbiny, Karim Essam, Hany Haggag, Abeer Awad Abdallatef, Kerolis Yousef, Rossella Maresca, Federico Barbaro, Galen Leung, Frances Dang, Amirali Tavangar, Jason Samarasena, Ahmed Saeed, Sherif Andrawes, Yutaka Tomizawa, Mohammad Bilal, Kartik Sampath, Yasi Xiao, Faisal Kamal, Thomas Kowalski, Alexander Schlachterman, Anand R. Kumar
Institutions: University of Minnesota, Thomas Jefferson University Hospital, Thomas Jefferson University, Johns Hopkins University, Chulalongkorn University, Johns Hopkins Medicine, King Chulalongkorn Memorial Hospital, Johns Hopkins Hospital, The Royal Free Hospital, University College London, Cairo University, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, NYU Langone Health, New York University, University of California, Irvine, Research Medical Center, Northwell Health, Staten Island University Hospital, University of Washington, University of Colorado Anschutz, NewYork–Presbyterian Hospital, Weill Cornell Medical Center
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,390
OpenAlex ID: W4415926187