Abstract
Background and study aims Endoscopic submucosal dissection (ESD) is useful for en bloc resection of superficial
colorectal neoplasms to ensure accurate histologic diagnoses. However, colorectal
ESD is associated with a high frequency of adverse events (AEs). We aimed to investigate
the effectiveness of prophylactic clip closure (PCC) of mucosal defects for AEs after
colorectal ESD.
Patients and methods This study included 197 patients with 211 lesions who underwent colorectal ESD between
June 2010 and August 2016. Patients who had delayed perforation, delayed bleeding,
abdominal pain, or fever were defined as AEs after colorectal ESD. Complete PCC was
defined as completely sutured mucosal defect using endoclips following colorectal
ESD, whereas incomplete PCC was defined as the mucosal defects that did not enable
PCC or were partially sutured. Clinical records were retrospectively reviewed and
clinical outcomes evaluated.
Results AEs occurred in 29 lesions (13.7 %), including 12 with delayed bleeding, 12 with fever,
2 with abdominal pain, 2 with fever and abdominal pain, and 1 with delayed bleeding
and fever. Delayed perforation was not observed in any patient. The frequency of AEs
was significantly lower in the group with complete PCC than in the group with incomplete
PCC (7.3 % [9/123] vs. 22.7 % [20/88]; P < 0.001). Multivariate analysis revealed that AEs after colorectal ESD were significantly
associated with tumor size and submucosal fibrosis. Subgroup analysis among the resected
specimen size of < 40 mm revealed that there was no significant difference in AEs
between the 2 groups (5.6 % [6/107] vs. 17.8 % [8/45]; P = 0.069). However, the frequency of fever with complete PCC was significantly lower
than that with incomplete PCC (2.8 % [3/107] vs. 13.3 % [6/45]; P = 0.020).
Conclusions Tumor size and submucosal fibrosis were independent risk factors for AEs after colorectal
ESD. PCC may be effective in minimizing AEs after colorectal ESD, especially the frequency
of fever.
