Preprint Communication Version 1 Preserved in Portico This version is not peer-reviewed

Clip Closure and PuraStat for Prevention of Clinically Significant Delayed Bleeding after Colorectal Endoscopic Submucosal Dissection: A Prospective, Observational Study

Mihai Ciocirlan
* ORCID logo ,
Dana Bilous
,
Andrei Gila
,
Daniel Corneliu Leucuta
ORCID logo ,
Daniela Elena Mihaila
,
Adrian Tulin
,
Anca Gheorghiu
,
Elena Tianu
,
Catalina Vladut
Version 1 : Received: 23 April 2024 / Approved: 23 April 2024 / Online: 24 April 2024 (09:58:17 CEST)

How to cite: Ciocirlan, M.; Bilous, D.; Gila, A.; Leucuta, D.C.; Mihaila, D.E.; Tulin, A.; Gheorghiu, A.; Tianu, E.; Vladut, C. Clip Closure and PuraStat for Prevention of Clinically Significant Delayed Bleeding after Colorectal Endoscopic Submucosal Dissection: A Prospective, Observational Study. Preprints 2024, 2024041562. https://doi.org/10.20944/preprints202404.1562.v1 Ciocirlan, M.; Bilous, D.; Gila, A.; Leucuta, D.C.; Mihaila, D.E.; Tulin, A.; Gheorghiu, A.; Tianu, E.; Vladut, C. Clip Closure and PuraStat for Prevention of Clinically Significant Delayed Bleeding after Colorectal Endoscopic Submucosal Dissection: A Prospective, Observational Study. Preprints 2024, 2024041562. https://doi.org/10.20944/preprints202404.1562.v1

Abstract

Background and aims. Clinically significant delayed bleeding (CSDB) may complicate endoscopic colorectal submucosal dissection (ESD). Methods. We assessed the results of a prospective registry of colorectal ESD. We evaluated the effect of clip closure and PuraStat application for prevention of CSDB. Results. 40 patients with 41 colorectal ESD were included. ESD was successful in 38 lesions (92.7%), 35 with R0 resection (92.1%) and 33 with curative resection (86.8%). CSDB occurred in 3 out 38 lesions (7.9%, 95% CI [1.7 – 21.4%]), exclusively after rectal ESD (3 of 22 rectal lesions vs. 0 of 16 colonic lesions, p = 0.249). Clip closure was more frequently used after colonic ESD (12 of 16 colonic lesions vs. 2 of 22 rectal lesions, p < 0.001) and was not protective for CSDB in univariate analysis, even though no events occurred after clip closure (0 of 14 lesions with clip closure vs. 3 of 27 lesions without, p = 0.283). PuraStat was more frequently applied after ESD for rectal lesions (16 of 22 rectal lesions vs. 2 of 16 colonic le-sions, p < 0.001) and was not protective for CSDB, all three events occurring after PuraStat application (3 of 21 lesions with PuraStat application vs. 0 of 20 lesions without, p = 0.097). Conclusions. CSDB occurred exclusively after rectal ESD, and no predictive factors were identified in uni-variate analysis. Clip closure and PuraStat application were not protective for CSDB.

Keywords

endoscopic submucosal dissection; clip closure; PuraStat; muscle retracting sign; colorectal mixed neuroendocrine carcinoma

Subject

Medicine and Pharmacology, Gastroenterology and Hepatology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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