TOPLINE:

Prophylactic defect closure after endoscopic submucosal dissection (ESD) of the colon was associated with lower rates of delayed bleeding and post-procedure hospital admission, with the benefit more pronounced in high-risk patients with right-sided colon polyps.

METHODOLOGY:

• ESD is increasingly used for large, nonpedunculated colorectal polyps, offering higher rates of en bloc resection and lower recurrence than endoscopic mucosal resection, but its technical complexity raises the risk for intraprocedural and delayed adverse events.
• Between 2017 and 2024, researchers conducted an international multicenter retrospective study comparing outcomes after complete defect closure (closed group) vs no attempted closure (open group) in patients undergoing colon ESD without intraprocedural perforations.
• The primary outcome was delayed adverse events within 2 weeks of ESD, defined as events requiring intervention or unplanned hospitalization. Investigators also assessed the risk for overnight hospital admission after the procedure.

TAKEAWAY:

• Researchers analyzed 560 patients (mean age, 64 years), with complete defect closure achieved in 71.8%.
• Delayed bleeding occurred significantly less often in the closed group than in the open group (1.7% vs 5.6%; P = .03). Right-sided polyps (adjusted odds ratio [aOR], 7.0; P = .017) and anticoagulation or antiplatelet use (aOR, 6.6; P = .007) increased delayed bleeding risk, whereas defect closure reduced it (aOR, 0.2; P = .033).
• The benefit of defect closure was greater for right-sided polyps (10.4% in the open group vs 2.4% in the closed group; P = .014).
• Defect closure did not lower the odds of delayed perforation but was associated with reduced overnight hospitalization (aOR, 0.56; P < .01).
• Among patients discharged the same day, prophylactic defect closure significantly reduced delayed bleeding (1% vs 5.8%; P = .036) and overall delayed adverse events (1.9% vs 7.2%; P = .043) compared with no attempted closure.

IN PRACTICE:

“The findings of this study suggest that, if feasible, ESD defects should be closed in the colon,” the authors of the study wrote.

SOURCE:

The study was led by Rahul Karna, Division of Gastroenterology & Hepatology, University of Minnesota, Minneapolis, and published online in Digestive Diseases and Sciences.

LIMITATIONS:

The study relied on recorded data accuracy, potentially affecting reliability. The definition of delayed adverse events as those requiring intervention or unplanned hospitalization excluded milder events. Variations in practice patterns, endoscopist experience, lesion selection, and hospitalization criteria introduced potential bias typical of multicenter retrospective studies.

DISCLOSURES:

The authors disclosed being consultants and/or paid speakers for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.