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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 on anticoagulants: A multicenter retrospective cohort study in Japan

Kazunori Takada 
1   Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan (Ringgold ID: RIN38471)
,
Naohisa Yoshida 
2   Molecular gastroenterology and hepatology, Kyoto prefectural university of medicine, Kyoto, Japan, Kyoto, Japan
,
Yoshikazu Hayashi 
3   Gastroenterology, Jichi Medical University, Shimotsuke-shi, Japan
,
Daichi Togo
4   Department of Gastroenterology, Sendai Kousei hospital, Sendai, Japan
,
Shiro Oka
5   Department of endoscopy, Hiroshima university hospial, Hiroshima, Japan
,
Shusei Fukunaga
6   Gastroenterology, Osaka City University Graduate School of Medicine of medicine, Osaka, Japan
,
Yoshinori Morita
7   Gastroentelorogy, Kobe University Hospital, Kobe, Japan
,
Takemasa Hayashi
8   Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
,
Kazunori Kozuka
9   Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan (Ringgold ID: RIN12850)
,
Yosuke Tsuji
10   Department of Gastroenterology, The University of Tokyo, Bunkyo-ku, Japan (Ringgold ID: RIN13143)
,
Takashi Murakami 
11   Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
12   Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
,
Takeshi Yamamura 
13   Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicne, Nagoya, Japan
,
Yoriaki Komeda
14   Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
,
Yoji Takeuchi
15   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan (Ringgold ID: RIN53312)
,
Kensuke Shinmura 
16   Gastroenterology,Endoscopy division, National Cancer Center Hospital East, kashiwa, Japan
,
Hiroko Fukuda
17   Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
,
Shinji Yoshii
18   Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine Graduate School of Medicine, Sapporo, Japan (Ringgold ID: RIN92187)
,
Shouko Ono
19   Endoscopy, Hokkaido University Hospital, Sapporo, Japan
,
Shinichi Katsuki
20   Fourth Department of Internal Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
,
Kazumasa Kawashima
21   Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan (Ringgold ID: RIN183174)
,
Daiki Nemoto
22   Department of Coloproctology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan
,
Hiroyuki Yamamoto
23   Gastroenterology, The Cancer Institute Hospital Of JFCR, Koto-ku, Japan (Ringgold ID: RIN117105)
,
Yutaka Saito
24   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Naoto Tamai
25   Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
Aya Tamura
26   Health Management Center, Toranomon Hospital, Minato-ku, Japan (Ringgold ID: RIN13600)
27   Division of Gastroenterology and Hepatology, Nihon University School of Medicine Internal Medicine, Itabashi-ku, Japan (Ringgold ID: RIN625025)
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Background and study aims: Prophylactic clip closure after colorectal endoscopic submucosal dissection (ESD) among patients on anticoagulants is of uncertain effectiveness in reducing delayed bleeding (DB) risk. We aimed to assess the effect of prophylactic clip closure in preventing DB after colorectal ESD among patients on anticoagulants. Patients and methods: We used the ABCD-J study database, a large-scale multicenter study analyzing DB among 34,455 colorectal ESD cases from 47 Japanese institutions. DB rates among the no/partial and complete closure groups were compared in patients on direct oral anticoagulants (DOACs) and warfarin. Propensity score matching for baseline characteristics was used to reduce the effects of selection bias. Results: Overall, 1,478 cases receiving colorectal ESD on anticoagulants 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 DB 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 DB among patients taking DOACs for right-sided lesions (ARR: 6.7%, P = 0.041), whereas no risk reduction was observed for left-sided (P = 1) or rectal lesions (P = 0.498). A similar trend was observed among patients on warfarin. Conclusions: Prophylactic complete clip closure after colorectal ESD significantly reduced the DB rate in patients receiving both DOACs and warfarin. It should be performed after ESD, particularly for right-sided lesions.



Publication History

Received: 06 September 2024

Accepted after revision: 18 December 2024

Accepted Manuscript online:
18 December 2024

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