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International Session（Panel Discussion）2(JGES・JSGE・JSGS)
Sat. November 2nd   14:00 - 17:00   Room 9: Portopia Hotel Main Building Kairaku 3
IS-PD2-3_G
 Effect of prophylactic clip closure in preventing delayed bleeding after colorectal endoscopic submucosal dissection among patients on anticoagulants: A post-hoc analysis of ABCD-J study
Kazunori Takada1, Naohisa Yoshida2, Naoyuki Yamaguchi3
1Division of Endoscopy, Shizuoka Cancer Center, 2Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 3Department of Gastroenterology and Hepatology, Nagasaki University Hospital
Aims:
We aimed to assess the effect of prophylactic clip closure in preventing delayed bleeding (DB) after colorectal endoscopic submucosal dissection (ESD) among patients on anticoagulants.
Methods:
This study was a post-hoc analysis of the ABCD-J study, which analyzed 1478 cases receiving anticoagulants in colorectal ESD from 47 Japanese institutions between 2012 and 2021. DB rates among the non-complete closure and complete closure groups were compared using propensity score matching in patients on direct oral anticoagulants (DOAC) and warfarin.
Results:
Among 1478 cases, 430 and 168 cases on DOAC and warfarin were extracted after propensity score matching, respectively. Complete closure group showed a significantly lower DB rate among patients on DOAC (10.7% vs. 5.1%, P=0.048) and warfarin (16.7% vs. 6.0%, P=0.049). In the subgroup analysis, complete closure significantly reduced the risk of DB among patients on DOAC in right-sided lesions (absolute risk reduction (ARR): 7.4%, P=0.028), whereas no risk reduction was observed in left-sided (ARR: 3.0%, P=0.605) and rectal lesions (ARR: 0%, P=1.00). Same trend was observed on warfarin.
Conclusions:
Prophylactic clip closure after colorectal ESD significantly reduces the rate of DB among patients on anticoagulants, especially in right-sided lesions.
Index Term 1: delayed bleeding
Index Term 2: anticoagulant
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