S0932 Is Prophylactic Endoscopic Clipping Closure Useful for Preventing Post-ESD Coagulation Syndrome (PECS) in Patients With Large Colorectal Neoplasm? The Answer From a Meta-Analysis

Abstract

INTRODUCTION: Endoscopic submucosal dissection (ESD) is an approved minimally invasive treatment for large colorectal tumor. Post ESD coagulation syndrome (PECS) is a complication describing as the inflammatory response condition (fever, abdominal pain, and leukocytosis) after ESD. Endoscopic clipping closure has been introduced to prevent this complication. The data on efficacy of closure is inconclusive among published literature. We conducted the meta-analysis aimed to determine the efficacy of prophylactic role of endoscopic clipping closure for PECS prevention in patients with large colorectal neoplasm. METHODS: We searched MEDLINE and EMBASE databases through May 2020 for published studies that compare the prophylactic efficacy of endoscopic clipping closure for preventing PECS in patients with colorectal neoplasm. The outcome of interest was the rate of PECS occurrence in groups of patients with and without clipping closure. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled risk ratio (RR) and 95% confidence intervals (CI). I2 statistics was used to assess heterogeneity among studies, with I2 > 50% indicates significant heterogeneity. RESULTS: Four studies were included in the meta-analysis and reported a total of 412 and 863 patients receiving and not receiving endoscopic closure, respectively. The occurrence of PECS in patients receiving prophylactic closure is comparable to control group with pooled RR of 0.55 (95% CI; 0.17–1.75, I2 = 68.3%) (Figure 1). CONCLUSION: This meta-analysis could not demonstrate the prophylactic efficacy of endoscopic clipping closure for PECS in patients with large colorectal tumor. However, the analysis was restricted by the small sample size. Further randomized controlled trials are still needed to clarify this effectiveness.Figure 1.: Forest plots demonstrating the efficacy of prophylactic endoscopic clip closure for PECS prevention in patients with colorectal cancer.