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; Naohisa Yoshida; Yoshikazu Hayashi; Daichi Togo; Shiro Oka; Shusei Fukunaga; Yoshinori Morita; Takemasa Hayashi; Kazuhiro Kozuka; Yosuke Tsuji; Takashi Murakami; Takeshi Yamamura; Yoriaki Komeda; Yoji Takeuchi; Kensuke Shinmura; Hiroko Fukuda; Shinji Yoshii; Shoko Ono; Shinichi Katsuki; Kazumasa Kawashima; Daiki Nemoto; Hiroyuki Yamamoto; Yutaka Saito; Naoto Tamai; Aya Tamura; on behalf of the ABCD-J Working Group

doi:10.1055/a-2505-7315

Endoscopy, Table of Contents

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

¹Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

,

Naohisa Yoshida

²Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

,

Yoshikazu Hayashi

³Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan

,

Daichi Togo

⁴Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan

,

Shiro Oka

⁵Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan

,

Shusei Fukunaga

⁶Department of Gastroenterology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan

,

Yoshinori Morita

⁷Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo, Japan

,

Takemasa Hayashi

⁸Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan

,

Kazuhiro Kozuka

⁹Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan

,

Yosuke Tsuji

¹⁰Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Takashi Murakami

¹¹Department of Gastroenterology, Juntendo University, Tokyo, Japan

,

Takeshi Yamamura

¹²Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan

,

Yoriaki Komeda

¹³Department of Gastroenterology, Kindai University, Osaka, Japan

,

Yoji Takeuchi

¹⁴Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

,

Kensuke Shinmura

¹⁵Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan

,

Hiroko Fukuda

¹⁶Department of Gastroenterology, Sasebo City General Hospital, Nagasaki, Japan

,

Shinji Yoshii

¹⁷Department of Gastroenterology, Sapporo Medical University, Hokkaido, Japan

,

Shoko Ono

¹⁸Department of Gastroenterology, Hokkaido University Hospital, Hokkaido, Japan

,

Shinichi Katsuki

¹⁹Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan

,

Kazumasa Kawashima

²⁰Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan

,

Daiki Nemoto

²¹Department of Coloproctology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan

,

Hiroyuki Yamamoto

²²Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

,

Yutaka Saito

²³Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

,

Naoto Tamai

²⁴Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

,

Aya Tamura

²⁵Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Nihon University, Tokyo, Japan

²⁶Health Management Center, Toranomon Hospital, Tokyo, Japan

,

on behalf of the ABCD-J Working Group

(

Yuki Itoi

²⁷Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan

,

Shigetsugu Tsuji

²⁸Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan

,

Yoshikazu Inagaki

²⁹Department of Gastroenterology, Nishizin Hospital, Kyoto, Japan

,

Yutaka Inada

³⁰Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan

,

Koichi Soga

³¹Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan

,

Daisuke Hasegawa

³²Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan

,

Takaaki Murakami

³³Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan

,

Hiroyuki Yoriki

³⁴Department of Gastroenterology, Otsu City Hospital, Shiga, Japan

,

Kohei Fukumoto

³⁵Department of Gastroenterology, Nara City Hospital, Nara, Japan

,

Takayuki Motoyoshi

³⁶Department of Gastroenterology, Kyoto City Hospital, Kyoto, Japan

,

Yasuki Nakatani

³⁷Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

,

Yasushi Sano

³⁸Gastrointestinal Center, Sano Hospital, Hyogo, Japan

,

Mikitaka Iguchi

³⁹Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

,

Shigehiko Fujii

⁴⁰Department of Gastroenterology, Kyoto Katsura Hospital, Kyoto, Japan

,

Hiromitsu Ban

⁴¹Department of Gastroenterology, Omi Medical Center, Shiga, Japan

,

Keita Harada

⁴²Department of Gastroenterology, Okayama University, Okayama, Japan

,

Koichi Okamoto

⁴³Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

,

Hitoshi Nishiyama

⁴⁴Department of Gastroenterology, Nagasaki Medical Center, Nagasaki, Japan

,

Fumisato Sasaki

⁴⁵Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

,

Kazuhiro Mizukami

⁴⁶Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan

,

Takashi Shono

⁴⁷Department of Gastroenterology, Kumamoto Central Hospital, Kumamoto, Japan

,

Ryo Shimoda

⁴⁸Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan

,

Tadashi Miike

⁴⁹Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

,

Naoyuki Yamaguchi

⁵⁰Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan

)› Author Affiliations

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.

Full Text

References

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