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Endoscopy
DOI: 10.1055/a-2505-7315
Original article

Prophylactic clip closure in preventing delayed bleeding after colorectal endoscopic submucosal dissection in patients on anticoagulants: a multicenter retrospective cohort study in Japan

Kazunori Takada 
1   Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
,
Naohisa Yoshida 
2   Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
,
Yoshikazu Hayashi 
3   Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
,
Daichi Togo
4   Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
,
Shiro Oka
5   Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
,
Shusei Fukunaga
6   Department of Gastroenterology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
,
Yoshinori Morita
7   Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo, Japan
,
Takemasa Hayashi
8   Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan
,
Kazuhiro Kozuka
9   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
,
Yosuke Tsuji
10   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Takashi Murakami 
11   Department of Gastroenterology, Juntendo University, Tokyo, Japan
,
Takeshi Yamamura 
12   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
,
Yoriaki Komeda
13   Department of Gastroenterology, Kindai University, Osaka, Japan
,
Yoji Takeuchi
14   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Kensuke Shinmura 
15   Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
,
Hiroko Fukuda
16   Department of Gastroenterology, Sasebo City General Hospital, Nagasaki, Japan
,
Shinji Yoshii
17   Department of Gastroenterology, Sapporo Medical University, Hokkaido, Japan
,
Shoko Ono
18   Department of Gastroenterology, Hokkaido University Hospital, Hokkaido, Japan
,
Shinichi Katsuki
19   Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan
,
Kazumasa Kawashima
20   Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
,
Daiki Nemoto
21   Department of Coloproctology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan
,
Hiroyuki Yamamoto
22   Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Yutaka Saito
23   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Naoto Tamai
24   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
Aya Tamura
25   Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Nihon University, Tokyo, Japan
26   Health Management Center, Toranomon Hospital, Tokyo, Japan
,
on behalf of the ABCD-J Working Group
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Einführung zu diesem Artikel:

To close or not to close after colorectal endoscopic submucosal dissection: that is the question!Endoscopy eFirst
DOI: 10.1055/a-2515-1779

Abstract

Background The effectiveness of prophylactic clip closure in reducing the risk of delayed bleeding after colorectal endoscopic submucosal dissection (ESD) is uncertain among patients on anticoagulants. We therefore aimed to assess this effectiveness using data from a large multicenter study.

Methods We used the ABCD-J study database to analyze delayed bleeding among 34 455 colorectal ESD cases from 47 Japanese institutions. Delayed bleeding rates among the no/partial and complete closure groups were compared in patients on direct oral anticoagulants (DOACs) or warfarin. Propensity score matching was used for baseline characteristics to reduce the effects of selection bias.

Results Overall, data from 1478 patients on anticoagulants who underwent colorectal ESD were examined. After propensity score matching, the complete and no/partial closure groups were compared in 212 patients on DOACs and 82 on warfarin. The complete closure group showed a significantly lower delayed bleeding rate in patients receiving DOACs (10.8 % vs. 5.2 %, absolute risk reduction [ARR] 5.7 %, P = 0.048) and warfarin (17.1 % vs. 6.1 %, ARR 11.0 %, P = 0.049). Additionally, complete closure significantly reduced the risk of delayed bleeding among patients taking DOACs for right-sided lesions (ARR 6.7 %, P = 0.04), whereas no risk reduction was observed for left-sided (P > 0.99) or rectal (P = 0.50) lesions. A similar trend was observed among patients on warfarin.

Conclusions Prophylactic complete clip closure after colorectal ESD significantly reduced the delayed bleeding rate in patients receiving DOACs or warfarin. It should be performed after ESD, particularly for right-sided lesions.

Supplementary Material



Publikationsverlauf

Eingereicht: 06. September 2024

Angenommen nach Revision: 18. Dezember 2024

Accepted Manuscript online:
18. Dezember 2024

Artikel online veröffentlicht:
31. Januar 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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