Left atrial appendage occlusion for bleeding risk control during endoscopic submucosal dissection in patients with chronic atrial fibrillation.

Percutaneous left atrial appendage occlusion prevents cardiogenic embolism caused by atrial fibrillation. It involves sealing the left atrial appendage using a specific closing device to avoid long-term anticoagulation. Here, we report an 88-year-old patient with colorectal cancer scheduled for endoscopic submucosal dissection (ESD) who had tumor surface bleeding and a high procedural hemorrhagic risk. During dual therapy with an antiplatelet agent and a direct oral anticoagulant (DOAC), left atrial appendage occlusion permitted DOAC discontinuation and reduced tumor bleeding. ESD was subsequently performed successfully and without complications under antiplatelet monotherapy.