Efficacy and Safety of Prophylactic Defect Closure After Colorectal ESD: A Systematic Review and Meta-Analysis with GRADE Certainty Assessment
In brief
Closure after colorectal ESD was linked to bleeding rates of 2.4% vs 6.9%
Across 16 studies involving 5,830 procedures, delayed bleeding occurred in 2.4% of cases with prophylactic closure and 6.9% without it. The review found no clear differences in delayed perforation, post-procedure syndrome, or hospital stay; small-study effects and low to very low certainty limit confidence, and closure may be most useful for patients at high bleeding risk.
- Journal
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (Q1)
- Published
- 6 November 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Faisal A Al-Harbi, Layan Bader Alrashoodi, Saud Khaled Alnughaymishi, Abdullah Saud Alharbi, Abdulilah Abdulrahman Aboalhaj, Abdulmalik Emad Alsalman, et al.
- PMID
- 42994606
- DOI
- 10.1016/j.gassur.2026.102665
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 8 November 2026): Meta-analysis informs prevention of delayed bleeding after colorectal ESD
Abstract
BACKGROUND: Colorectal endoscopic submucosal dissection (ESD) leaves a large mucosal defect that predisposes patients to delayed adverse events, chiefly delayed bleeding. Prophylactic closure of the defect has been proposed to improve safety, but its overall efficacy remains uncertain. This systematic review and meta-analysis provides an updated synthesis of the safety and efficacy of prophylactic mucosal defect closure after colorectal ESD. METHODS: PubMed, Web of Science, and Scopus were searched from inception to June 2026, without language restrictions, for randomized controlled trials and comparative observational studies comparing prophylactic closure with no closure after colorectal ESD. The primary outcome was delayed bleeding; secondary outcomes were delayed perforation, post-ESD coagulation syndrome (PECS), and length of hospital stay. Pooled RRs and mean differences with 95% CIs were calculated using random-effects models, and the certainty of evidence was assessed with GRADE. RESULTS: Sixteen studies comprising 5,830 procedures were included. Prophylactic closure was associated with a lower risk of delayed bleeding (RR 0.42; 95% CI, 0.28 to 0.62; I² = 63.9%), with pooled delayed bleeding rates of 2.4% with closure and 6.9% without closure. No difference was observed for delayed perforation (RR 0.89; 95% CI, 0.37 to 2.17), PECS (RR 1.12; 95% CI, 0.50 to 2.49), or length of hospital stay (mean difference 0.16 days; 95% CI, -0.61 to 0.93). Small-study effects were detected for delayed bleeding, and the certainty of evidence ranged from low to very low. CONCLUSIONS: Prophylactic closure after colorectal ESD reduced delayed bleeding. No effect on delayed perforation, PECS, or length of hospital stay was shown, although these estimates were imprecise. Closure may be best reserved for patients at high risk of 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.