Kumar Anand R, Madaka Pranita, Le Joria, Ines Reygenald D, Tolosa Celestina, Ngamruengphong Saowanee, Milne Fiona, Bechara Robert, Steinberg Jonathan, D'Souza Lionel S, Dang Frances, Samarasena Jason, Leung Galen, Lucaciu Laura, Despott Edward John, Barbaro Federico, Chiappetta Michele, Inamdar Sumant, Karna Rahul, Bilal Mohammad, Tomizawa Yutaka, Alsamman Amer, Ladd Antonio Mendoza, Xiao Yasi, Kamal Faisal, Schlachterman Alexander, Kowalski Thomas
Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Drexel University, Philadelphia, PA, USA.
Dig Dis Sci. 2025 Jun 24. doi: 10.1007/s10620-025-09123-7.
Prophylactic endoscopic submucosal dissection (ESD) defect closure has been suggested to reduce delayed adverse events (DAE) associated with ESD but the data are limited. We aim to study the effect of prophylactic rectal ESD defect closure on post-ESD outcomes.
An international multicenter retrospective cohort study was performed between 2016 and 2023 involving patients who underwent rectal ESD without intraprocedural perforations and had follow-up data available for at least 2 weeks post-ESD. Delayed adverse events (DAE) defined as bleeding and perforation within 2 weeks of ESD and post-procedure hospitalization or observation rates were compared between the two groups - ESD defects closed (closure group) and ESD defects open (open group).
A total of 385 patients were included. Complete closure of ESD defects was performed in 166 (43%) patients. DAE were observed in 21 (5.5%) patients. On logistic regression analysis, anticoagulant use, NICE3 lesions and incomplete resections had significantly higher rate of DAE. In these high-risk groups, defect closure had a numerically lower rate of DAE without statistical significance. While defect closure did not significantly reduce the rate of overall DAE (p = 0.16), there were no delayed perforations in the closure group compared to 3 (1.3%) in the open group. A significantly lower number of patients were kept for post-ESD overnight hospital observation in the closure group compared to the open group (17% v 37%, p < 0.01).
Prophylactic closure of rectal ESD defects leads to significantly less overnight hospital observation. Anticoagulant use, NICE 3 lesions and incomplete resections had significantly higher DAE within 2 weeks. While defect closure did not significantly reduce the overall DAE, selective prophylactic defect closure in high-risk groups will need to be studied in larger samples.
预防性内镜黏膜下剥离术（ESD）缺损闭合术被认为可减少与ESD相关的延迟性不良事件（DAE），但相关数据有限。我们旨在研究预防性直肠ESD缺损闭合术对ESD术后结局的影响。
2016年至2023年进行了一项国际多中心回顾性队列研究，纳入了接受直肠ESD且术中未发生穿孔且ESD术后至少有2周随访数据的患者。比较两组患者（ESD缺损闭合组（闭合组）和ESD缺损开放组（开放组））在ESD后2周内定义为出血和穿孔的延迟性不良事件（DAE）以及术后住院或观察率。
共纳入385例患者。166例（43%）患者的ESD缺损实现了完全闭合。21例（5.5%）患者观察到DAE。逻辑回归分析显示，使用抗凝剂、NICE3病变和切除不完全的患者发生DAE的比率显著更高。在这些高危组中，缺损闭合的DAE发生率在数值上较低，但无统计学意义。虽然缺损闭合并未显著降低总体DAE发生率（p = 0.16），但闭合组未出现延迟性穿孔，而开放组有3例（1.3%）。与开放组相比，闭合组术后需留院过夜观察的患者数量显著更少（17%对37%，p < 0.01）。
预防性闭合直肠ESD缺损可显著减少术后过夜观察。使用抗凝剂、NICE 3病变和切除不完全的患者在2周内发生DAE的比率显著更高。虽然缺损闭合并未显著降低总体DAE，但高危组的选择性预防性缺损闭合需要在更大样本中进行研究。
