{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:52:09Z","timestamp":1792468329855,"version":"4.5.0"},"reference-count":44,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Background\u2002The effectiveness of prophylactic clip closure in reducing the risk of delayed bleeding after colorectal endoscopic submucosal dissection (ESD) is uncertain among patients on anticoagulants. We therefore aimed to assess this effectiveness using data from a large multicenter study.<\/jats:p>\n                  <jats:p>Methods\u2002We used the ABCD-J study database to analyze delayed bleeding among 34\u200a455 colorectal ESD cases from 47 Japanese institutions. Delayed bleeding rates among the no\/partial and complete closure groups were compared in patients on direct oral anticoagulants (DOACs) or warfarin. Propensity score matching was used for baseline characteristics to reduce the effects of selection bias.<\/jats:p>\n                  <jats:p>Results\u2002Overall, data from 1478 patients on anticoagulants who underwent colorectal ESD were examined. After propensity score matching, the complete and no\/partial closure groups were compared in 212 patients on DOACs and 82 on warfarin. The complete closure group showed a significantly lower delayed bleeding rate in patients receiving DOACs (10.8\u200a% vs. 5.2\u200a%, absolute risk reduction [ARR] 5.7\u200a%, P\u200a=\u200a0.048) and warfarin (17.1\u200a% vs. 6.1\u200a%, ARR 11.0\u200a%, P\u200a=\u200a0.049). Additionally, complete closure significantly reduced the risk of delayed bleeding among patients taking DOACs for right-sided lesions (ARR 6.7\u200a%, P\u200a=\u200a0.04), whereas no risk reduction was observed for left-sided (P\u200a&gt;\u200a0.99) or rectal (P\u200a=\u200a0.50) lesions. A similar trend was observed among patients on warfarin.<\/jats:p>\n                  <jats:p>Conclusions\u2002Prophylactic complete clip closure after colorectal ESD significantly reduced the delayed bleeding rate in patients receiving DOACs or warfarin. It should be performed after ESD, particularly for right-sided lesions.<\/jats:p>","DOI":"10.1055\/a-2505-7315","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T19:00:11Z","timestamp":1734548411000},"page":"631-642","source":"Crossref","is-referenced-by-count":22,"title":["Prophylactic clip closure in preventing delayed bleeding after colorectal endoscopic submucosal dissection in patients on anticoagulants: a multicenter retrospective cohort study in Japan"],"prefix":"10.1055","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5074-373X","authenticated-orcid":false,"given":"Kazunori","family":"Takada","sequence":"additional","affiliation":[{"name":"Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-9705","authenticated-orcid":false,"given":"Naohisa","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-639X","authenticated-orcid":false,"given":"Yoshikazu","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daichi","family":"Togo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Oka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shusei","family":"Fukunaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Morita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takemasa","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Kozuka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7419-589X","authenticated-orcid":false,"given":"Takashi","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Juntendo University, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4994-016X","authenticated-orcid":false,"given":"Takeshi","family":"Yamamura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoriaki","family":"Komeda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Kindai University, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoji","family":"Takeuchi","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8786-4634","authenticated-orcid":false,"given":"Kensuke","family":"Shinmura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sasebo City General Hospital, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Yoshii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Sapporo Medical University, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoko","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hokkaido University Hospital, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Katsuki","sequence":"additional","affiliation":[{"name":"Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazumasa","family":"Kawashima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Nemoto","sequence":"additional","affiliation":[{"name":"Department of Coloproctology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Saito","sequence":"additional","affiliation":[{"name":"Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Tamai","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya","family":"Tamura","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Nihon University, Tokyo, Japan"},{"name":"Health Management Center, Toranomon Hospital, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the ABCD-J Working 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prospective, multicenter, cohort trial from Japan","volume":"163","author":"K Ohata","year":"2022","journal-title":"Gastroenterology"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/DCR.0000000000000335","article-title":"Hospital volume and the occurrence of bleeding and perforation after colorectal endoscopic submucosal dissection: analysis of a national administrative database in Japan","volume":"58","author":"H Odagiri","year":"2015","journal-title":"Dis Colon Rectum"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s00384-016-2540-7","article-title":"High incidence of postoperative hemorrhage in colorectal endoscopic submucosal dissection during anticoagulant therapy","volume":"31","author":"N Yoshida","year":"2016","journal-title":"Int J Colorectal Dis"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"E857","DOI":"10.1055\/a-0593-5788","article-title":"Use of anticoagulants increases risk of bleeding after colorectal endoscopic submucosal dissection","volume":"6","author":"K Yamashita","year":"2018","journal-title":"Endosc Int Open"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"E1654","DOI":"10.1055\/a-1244-2097","article-title":"Effect of anticoagulants on the risk of delayed bleeding after colorectal endoscopic submucosal dissection","volume":"8","author":"H Ogiyama","year":"2020","journal-title":"Endosc Int Open"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.cgh.2023.09.012","article-title":"An analysis of delayed bleeding in cases of colorectal endoscopic submucosal dissection due to types of direct oral anticoagulants in Japan","volume":"22","author":"N Yoshida","year":"2024","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.gie.2020.10.004","article-title":"Prophylactic clips to reduce delayed polypectomy bleeding after resection of large colorectal polyps: a systematic review and meta-analysis of randomized trials","volume":"93","author":"B Chen","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/S2468-1253(21)00384-8","article-title":"Effect of prophylactic endoscopic clip placement on clinically significant post-endoscopic mucosal resection bleeding in the right colon: a single-centre, randomised controlled trial","volume":"7","author":"S Gupta","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.cgh.2021.05.012","article-title":"the role of clips in preventing delayed bleeding after colorectal polyp resection: an individual patient data meta-analysis","volume":"20","author":"A S Turan","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"E582","DOI":"10.1055\/a-0581-8886","article-title":"Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection","volume":"6","author":"H Ogiyama","year":"2018","journal-title":"Endosc Int Open"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1080\/00365521.2021.1953129","article-title":"The efficacy of prophylactic clip closure of mucosal defects after colorectal endoscopic submucosal dissection on delayed bleeding","volume":"56","author":"A Miyakawa","year":"2021","journal-title":"Scand J Gastroenterol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/den.14397","article-title":"Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: literature review over one decade","volume":"35","author":"H Kobara","year":"2023","journal-title":"Dig Endosc"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1111\/jgh.15148","article-title":"Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: a meta-analysis","volume":"35","author":"M Liu","year":"2020","journal-title":"J Gastroenterol Hepatol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1080\/00365521.2019.1674918","article-title":"Effect of prophylactic endoscopic closure for an artificial ulceration after colorectal endoscopic submucosal dissection: a randomized controlled trial","volume":"54","author":"S P Lee","year":"2019","journal-title":"Scand J Gastroenterol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.gie.2019.11.030","article-title":"A multicenter, single-blind randomized controlled trial of endoscopic clipping closure for preventing coagulation syndrome after colorectal endoscopic submucosal dissection","volume":"91","author":"S Nomura","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/den.13545","article-title":"Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection\/endoscopic mucosal resection","volume":"32","author":"S Tanaka","year":"2020","journal-title":"Dig Endosc"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/den.12456","article-title":"JGES guidelines for colorectal endoscopic submucosal dissection\/endoscopic mucosal resection","volume":"27","author":"S Tanaka","year":"2015","journal-title":"Dig Endosc"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1055\/s-2007-995530","article-title":"Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection \u2013 an analysis of risk factors","volume":"40","author":"K Takizawa","year":"2008","journal-title":"Endoscopy"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.cgh.2014.07.063","article-title":"Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps","volume":"13","author":"F F Bahin","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.gie.2019.05.039","article-title":"Prophylactic endoscopic coagulation to prevent delayed post-EMR bleeding in the colorectum: a prospective randomized controlled trial (with videos)","volume":"90","author":"H S Lee","year":"2019","journal-title":"Gastrointest Endosc"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.gie.2013.08.041","article-title":"Endoscopic tissue shielding method with polyglycolic acid sheets and fibrin glue to cover wounds after colorectal endoscopic submucosal dissection (with video)","volume":"79","author":"Y Tsuji","year":"2014","journal-title":"Gastrointest Endosc"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/den.12183","article-title":"Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment","volume":"26","author":"K Fujimoto","year":"2014","journal-title":"Dig Endosc"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/den.13184","article-title":"Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment: 2017 appendix on anticoagulants including direct oral anticoagulants","volume":"30","author":"M Kato","year":"2018","journal-title":"Dig Endosc"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.3109\/00365521.2010.495416","article-title":"Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis","volume":"45","author":"A Matsumoto","year":"2010","journal-title":"Scand J Gastroenterol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.gie.2018.11.029","article-title":"A risk-scoring model for the prediction of delayed bleeding after colorectal endoscopic submucosal dissection","volume":"89","author":"M Seo","year":"2019","journal-title":"Gastrointest Endosc"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1111\/den.14761","article-title":"Efficacy of prophylactic clip closure in reducing the risk of delayed bleeding after colorectal endoscopic submucosal dissection in patients on anticoagulant therapy: multicenter prospective study","volume":"36","author":"H Ogiyama","year":"2024","journal-title":"Dig Endosc"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1055\/a-2189-0807","article-title":"Risk of delayed bleeding after colorectal endoscopic submucosal dissection: the Limoges Bleeding Score","volume":"56","author":"J Albouys","year":"2024","journal-title":"Endoscopy"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1053\/j.gastro.2019.03.019","article-title":"Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial","volume":"157","author":"H Pohl","year":"2019","journal-title":"Gastroenterology"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1053\/j.gastro.2019.07.037","article-title":"Clip closure after resection of large colorectal lesions with substantial risk of bleeding","volume":"157","author":"E Albeniz","year":"2019","journal-title":"Gastroenterology"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1053\/j.gastro.2019.11.015","article-title":"Routine prophylactic clip closure is cost saving after endoscopic resection of large colon polyps in a Medicare population","volume":"158","author":"E D Shah","year":"2020","journal-title":"Gastroenterology"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"311","DOI":"10.14309\/ajg.0000000000000943","article-title":"The answer to \u201cwhen to clip\u201d after colorectal endoscopic mucosal resection based on a cost-effectiveness analysis","volume":"116","author":"E Albeniz","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1111\/den.14427","article-title":"Suturing techniques with endoscopic clips and special devices after endoscopic resection","volume":"35","author":"T Nomura","year":"2023","journal-title":"Dig Endosc"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1080\/00365521.2021.1949491","article-title":"Endoloop closure following gastric endoscopic submucosal dissection to prevent delayed bleeding in patients receiving antithrombotic therapy","volume":"56","author":"K Shiotsuki","year":"2021","journal-title":"Scand J Gastroenterol"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"85","DOI":"10.3892\/or.2013.2466","article-title":"The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection","volume":"30","author":"S Fujihara","year":"2013","journal-title":"Oncol Rep"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"E1212","DOI":"10.1055\/a-1197-6534","article-title":"Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection","volume":"8","author":"S Han","year":"2020","journal-title":"Endosc Int Open"},{"key":"ref38","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1055\/a-1120-8533","article-title":"A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study","volume":"52","author":"S Abe","year":"2020","journal-title":"Endoscopy"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.gie.2023.02.031","article-title":"Novel through-the-scope suture closure of colonic EMR defects (with video)","volume":"98","author":"D Bi","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.gie.2008.11.024","article-title":"Prophylactic argon plasma coagulation ablation does not decrease delayed postpolypectomy bleeding","volume":"70","author":"C K Lee","year":"2009","journal-title":"Gastrointest Endosc"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.gie.2013.08.040","article-title":"Removal of small colorectal polyps in anticoagulated patients: a prospective randomized comparison of cold snare and conventional polypectomy","volume":"79","author":"A Horiuchi","year":"2014","journal-title":"Gastrointest 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Gastroenterol"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2505-7315.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T18:31:19Z","timestamp":1748457079000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2505-7315"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,18]]},"references-count":44,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2025,5,28]]},"published-print":{"date-parts":[[2025,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2505-7315","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,12,18]]},"published":{"date-parts":[[2024,12,18]]}}}