Clip Closure and PuraStat for Prevention of Clinically Significant Delayed Bleeding after Colorectal Endoscopic Submucosal Dissection: A Prospective, Observational Study

Abstract

Background and aims. Clinically significant delayed bleeding (CSDB) may complicate endoscopic colorectal submucosal dissection (ESD). We aimed to assess the efficacy of preventive measures for CSDB. Methods. We assessed the results of a prospective registry of colorectal ESD for laterally spreading lesions. We evaluated the effect of clip closure and PuraStat application on the prevention of CSDB. Results. A total of 40 patients with 41 colorectal ESDs were included. ESD was successful in 38 lesions (92.7%), 35 with R0 resection (92.1%) and 33 with curative resection (86.8%). CSDB occurred in 3 of 38 lesions (7.9%, 95% CI [1.7–21.4%]), exclusively after rectal ESD (3 of 22 rectal lesions vs. 0 of 16 colonic lesions, p = 0.249). Clip closure was more frequently used after colonic ESD (12 of 16 colonic lesions vs. 2 of 22 rectal lesions, p < 0.001) and was not protective for CSDB in the univariate analysis, even though no events occurred after clip closure (0 of 14 lesions with clip closure vs. 3 of 24 lesions without, p = 0.283). PuraStat was more frequently applied after ESD for rectal lesions (16 of 22 rectal lesions vs. 2 of 16 colonic lesions, p < 0.001) and was not protective for CSDB, with all three events occurring after PuraStat application (3 of 18 lesions with PuraStat application vs. 0 of 20 lesions without, p = 0.097). Conclusions. CSDB occurred exclusively after rectal ESD, and no predictive factors were identified in the univariate analysis. Clip closure and PuraStat application were not protective for CSDB.