Reassessing the prophylactic effect of clip closure to prevent delayed rebleeding after colorectal endoscopic submucosal dissection

We read with great interest the recent EPOC trial by Miyakawa et al , published in Gut , investigating the efficacy of prophylactic clip closure following colorectal endoscopic submucosal dissection (ESD). The authors deserve recognition and appreciation for conducting a well-designed, multicentre randomised controlled trial (RCT) that focused on clinically meaningful endpoints and included a robust per-protocol analysis. Notably, this study addresses a significant gap in the literature by setting delayed bleeding as the primary outcome, which distinguishes it from prior trials where bleeding was only a secondary endpoint. The findings provide valuable evidence supporting the role of prophylactic clip closure in enhancing post-ESD outcomes. While the study undoubtedly holds considerable value, we wish to respectfully raise several concerns regarding the interpretation and generalisability of the findings, particularly concerning the reported incidence of delayed bleeding. The reported absolute delayed …