Endoscopy · 2025
Impact of prophylactic clipping on delayed bleeding after colorectal endoscopic submucosal dissection: a multicenter propensity score-matched study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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De Cristofaro Elena, Jacques Jérémie, Montori Sheyla, Wallenhorst Timothée, Lepilliez Vincent, Degand Thibault, Le Baleur Yann, Leclercq Philippe, Berger Arthur, Chabrun Edouard, Brieau Bertrand, Barret Maximilien, Albéniz Eduardo, Rahmi Gabriel, Legros Romain, Rivory Jérôme, Leblanc Sarah, Vanbiervliet Geoffroy, Albouys Jérémie, Yzet Clara, Belle Arthur, Rostain Florian, Chevaux Jean-Baptiste, Schaefer Marion, Pioche Mathieu, FECCo Working Group
Аннотация
BACKGROUND: Clinically significant delayed bleeding (CSDB) is the most common complication after colorectal endoscopic submucosal dissection (ESD). The Limoges Bleeding Score (LBS) was developed to identify high-risk patients. The efficacy of prophylactic clipping in reducing CSDB remains debated. This study assessed the effectiveness of complete clip closure in preventing CSDB after colorectal ESD.
METHODS: A retrospective analysis of prospectively collected data from 10 centers (2019-2022) was conducted. ESD-treated epithelial colorectal lesions were included. Patients were categorized into closure and non-closure groups, and compared using propensity score matching (PSM) based on LBS factors (age > 75, lesion > 50 mm, American Society of Anesthesiologists III-IV, rectal location, anticoagulant/antiplatelet use). Subgroup analyses focused on anticoagulant use and high-risk patients (LBS 5-8). Environmental impact was estimated based on a representative sample.
RESULTS: Among 3142 patients (1199 closure, 1943 non-closure), 216 (6.9 %) developed CSDB, with no difference between groups (closure: 7.2 % vs. non-closure: 6.9 %; P = 0.66). PSM analysis (944 matched cases) confirmed no statistically significant difference in CSDB (7.7 % vs. 5.7 %, respectively; P = 0.10). Subgroup analyses in patients on anticoagulants and at high risk showed no significant differences between the two groups (P = 0.39 and P = 0.73, respectively). Mean waste and carbon footprint was 283.2 g and 2.9 kg carbon dioxide equivalents, respectively, for single-use clips per closure (clip-to-lesion ratio: 0.8 clips/cm).
CONCLUSIONS: Prophylactic clipping did not significantly reduce CSDB following colorectal ESD, even in high-risk patients. Given its environmental impact and technical challenges, routine closure should be reconsidered.
METHODS: A retrospective analysis of prospectively collected data from 10 centers (2019-2022) was conducted. ESD-treated epithelial colorectal lesions were included. Patients were categorized into closure and non-closure groups, and compared using propensity score matching (PSM) based on LBS factors (age > 75, lesion > 50 mm, American Society of Anesthesiologists III-IV, rectal location, anticoagulant/antiplatelet use). Subgroup analyses focused on anticoagulant use and high-risk patients (LBS 5-8). Environmental impact was estimated based on a representative sample.
RESULTS: Among 3142 patients (1199 closure, 1943 non-closure), 216 (6.9 %) developed CSDB, with no difference between groups (closure: 7.2 % vs. non-closure: 6.9 %; P = 0.66). PSM analysis (944 matched cases) confirmed no statistically significant difference in CSDB (7.7 % vs. 5.7 %, respectively; P = 0.10). Subgroup analyses in patients on anticoagulants and at high risk showed no significant differences between the two groups (P = 0.39 and P = 0.73, respectively). Mean waste and carbon footprint was 283.2 g and 2.9 kg carbon dioxide equivalents, respectively, for single-use clips per closure (clip-to-lesion ratio: 0.8 clips/cm).
CONCLUSIONS: Prophylactic clipping did not significantly reduce CSDB following colorectal ESD, even in high-risk patients. Given its environmental impact and technical challenges, routine closure should be reconsidered.