Prophylactic Clip Closure in Preventing Delayed Bleeding After Colorectal Endoscopic Submucosal Dissection on anticoagulants: A multicenter retrospective cohort study in Japan.

Abstract

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.