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Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis
Author(s) -
Liu Mingqing,
Zhang Yangyu,
Wang Yueqi,
Zhu He,
Xu Hong
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15148
Subject(s) - medicine , endoscopic submucosal dissection , perforation , meta analysis , incidence (geometry) , surgery , endoscopic mucosal resection , therapeutic endoscopy , cochrane library , adverse effect , endoscopy , materials science , punching , physics , optics , metallurgy
Abstract Background and Aim Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large colorectal lesions. However, colorectal ESD is associated with a high frequency of adverse events (AEs), and the efficacy of prophylactic endoscopic closure after ESD for preventing AEs is still controversial. This meta‐analysis was conducted to assess the efficacy of closure on AEs following colorectal ESD. Methods We searched PubMed, Embase, and the Cochrane Library for eligible studies. The chi‐square‐based Q statistics and the I 2 test were used to test for heterogeneity. Pooling was conducted using a fixed or random effects model. Results We identified eight eligible studies that compared the effects of closure vs non‐closure with respect to delayed bleeding, delayed perforation, and post‐ESD coagulation syndrome. Compared with non‐closure (5.2%), closure was associated with a lower incidence (0.9%) of delayed bleeding (pooled odd ratios [ORs]:0.19, 95% CI: 0.08–0.49) following ESD. The pooled ORs showed no significant differences in incidence of delayed perforation (pooled OR: 0.22; 95% CI: 0.05–1.03) or post‐ESD coagulation syndrome (pooled OR:0.75; 95% CI: 0.26–2.18) between the closure and non‐closure groups. Conclusion Prophylactic endoscopic closure may reduce the incidence of delayed bleeding following ESD of colorectal lesions. Future studies are needed to further illuminate risk factors and stratify high risk subjects for a cost‐effective preventive strategy.