Prophylactic clip closure for the prevention of delayed bleeding after colorectal endoscopic submucosal dissection: a systematic review and meta-analysis of randomized controlled trials
In brief
Prophylactic clips cut post-ESD bleeding risk by two-thirds
A meta-analysis of five randomized trials (772 patients) found that applying clips after colorectal endoscopic submucosal dissection reduced bleeding events to about one-third of the rate seen without clipping. The same approach did not change rates of perforation or post-ESD coagulation syndrome. These data support routine clip closure to lower bleeding, though larger studies are needed to confirm safety across all lesion types.
- Journal
- European journal of gastroenterology & hepatology (Q2)
- Published
- 12 June 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Aamir Saeed, Saira Yousuf, Hina Akbar, Mark Radlinski, Leonard Baidoo, Claudio Tombazzi, et al.
- PMID
- 42467919
- DOI
- 10.1097/MEG.0000000000003234
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 19 July 2026): Meta-analysis of RCTs on prophylactic clipping after ESD
- Picked for Hepatology (top studies of the week, 19 July 2026).
Abstract
Prophylactic clip closure after endoscopic submucosal dissection (ESD) may be beneficial in the prevention of adverse events. In this meta-analysis of randomized controlled trials, we have evaluated the role of prophylactic clipping after ESD. We reviewed multiple databases from inception to 24 January 2026. Outcomes of interest included post-ESD bleeding, perforation, and post-ESD coagulation syndrome. Risk ratios with 95% confidence intervals (CIs) were calculated. Data were analyzed using a random-effects model. Heterogeneity was assessed using the I2 statistic. Five randomized controlled trials with 772 patients were included. Prophylactic clipping was associated with a lower risk of post-ESD bleeding (risk ratio: 0.35, 95% CI: 0.18, 0.65). There was no significant difference in risk of post-ESD coagulation syndrome (risk ratio: 1.06, 95% CI: 0.73, 1.53), and perforation (risk ratio: 0.72, 95% CI: 0.23, 2.30) between the groups. In conclusion, this meta-analysis demonstrates the benefits of prophylactic clipping after colorectal ESD in the prevention of post-ESD bleeding.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.