Prophylactic clipping after colorectal ESD reduces delayed bleeding risk by 74%

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Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Alfarone Ludovico, Spadaccini Marco, Rizkala Tommy, deSire Roberto, Massimi Davide, Capogreco Antoni… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider prophylactic clipping after colorectal ESD to reduce delayed bleeding risk, though subgroup analyses were not significant.

This systematic review and meta-analysis evaluated the efficacy and safety of prophylactic clipping after colorectal endoscopic submucosal dissection (ESD) in adults. The analysis included 684 patients from multiple studies, comparing clipping versus no clipping.

The primary outcome was clinically significant delayed bleeding. Clipping was associated with a significant reduction in risk (RR 0.26, 95%CI 0.08-0.88), with absolute rates of 0.3% in the clipping group versus 3.4% in the no-clipping group. For secondary outcomes, there were no significant differences between groups for postprocedural perforation (RR 0.74, 95%CI 0.23-2.35; 0.4% vs. 1.0%) or postelectrocoagulation syndrome (RR 1.06, 95%CI 0.74-1.52; 12.2% vs. 11.8%).

The authors note that subgroup analyses by lesion size and location were not significant, which tempers the strength of the primary finding. Safety outcomes such as adverse events and tolerability were not reported. Despite these limitations, the pooled evidence supports adoption of prophylactic clipping in routine practice to reduce delayed bleeding after colorectal ESD.

Study Details

Study typeMeta analysis

Sample sizen = 684

EvidenceLevel 1

PublishedJun 2026

PMID41760121

View Original Abstract ↓

BACKGROUND: Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for large nonpedunculated colorectal polyps; however, it carries a relevant risk of adverse events (AEs), such as delayed bleeding, as well as postprocedural perforation (PPP) and postelectrocoagulation syndrome (PECS). Systematic defect closure may reduce these risks, but its preventive efficacy remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of prophylactic clipping after colorectal ESD. METHODS: Following PRISMA guidelines, we searched MEDLINE, Embase, and SCOPUS through to June 2025 for RCTs comparing prophylactic clipping vs. no clipping after colorectal ESD in adults. The primary outcome was clinically significant delayed bleeding; secondary outcomes included PPP and PECS, as well as subanalysis by location and size. Random-effects models were used to compute risk ratios (RRs) and 95%CIs. RESULTS: Four RCTs from Asia including 684 patients were analyzed (336 with clipping, 348 controls). Prophylactic clipping significantly reduced clinically significant delayed bleeding risk (0.3% vs. 3.4%; RR 0.26, 95%CI 0.08-0.88). No significant differences were found for PPP (0.4% vs. 1.0%; RR 0.74; 95%CI 0.23-2.35) or PECS (12.2% vs. 11.8%; RR 1.06; 95%CI 0.74-1.52). Subgroup analyses by lesion size (>30 mm vs. <30 mm) and location (proximal vs. distal colon) were not significant. CONCLUSIONS: A 74% decrease in the risk of clinically significant delayed bleeding is achieved by prophylactic clipping after colorectal ESD, supporting its adoption in routine practice.