{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:15:43Z","timestamp":1790201743138,"version":"4.1.0"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Background\u2002Clinically significant delayed bleeding (CSDB) is the most common complication after colorectal endoscopic submucosal dissection (ESD). The Limoges Bleeding Score (LBS) was developed to identify high-risk patients. The efficacy of prophylactic clipping in reducing CSDB remains debated. This study assessed the effectiveness of complete clip closure in preventing CSDB after colorectal ESD.<\/jats:p>\n                  <jats:p>Methods\u2002A retrospective analysis of prospectively collected data from 10 centers (2019\u20132022) was conducted. ESD-treated epithelial colorectal lesions were included. Patients were categorized into closure and non-closure groups, and compared using propensity score matching (PSM) based on LBS factors (age &gt;\u200a75, lesion &gt;\u200a50\u200amm, American Society of Anesthesiologists III\u2013IV, rectal location, anticoagulant\/antiplatelet use). Subgroup analyses focused on anticoagulant use and high-risk patients (LBS 5\u20138). Environmental impact was estimated based on a representative sample.<\/jats:p>\n                  <jats:p>Results\u2002Among 3142 patients (1199 closure, 1943 non-closure), 216 (6.9\u200a%) developed CSDB, with no difference between groups (closure: 7.2\u200a% vs. non-closure: 6.9\u200a%; P\u200a=\u200a0.66). PSM analysis (944 matched cases) confirmed no statistically significant difference in CSDB (7.7\u200a% vs. 5.7\u200a%, respectively; P\u200a=\u200a0.10). Subgroup analyses in patients on anticoagulants and at high risk showed no significant differences between the two groups (P\u200a=\u200a0.39 and P\u200a=\u200a0.73, respectively). Mean waste and carbon footprint was 283.2\u200ag and 2.9\u200akg carbon dioxide equivalents, respectively, for single-use clips per closure (clip-to-lesion ratio: 0.8 clips\/cm).<\/jats:p>\n                  <jats:p>Conclusions\u2002Prophylactic clipping did not significantly reduce CSDB following colorectal ESD, even in high-risk patients. Given its environmental impact and technical challenges, routine closure should be reconsidered.<\/jats:p>","DOI":"10.1055\/a-2723-5162","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T23:09:16Z","timestamp":1760483356000},"page":"262-272","source":"Crossref","is-referenced-by-count":10,"title":["Impact of prophylactic clipping on delayed bleeding after colorectal endoscopic submucosal dissection: a multicenter propensity score-matched study"],"prefix":"10.1055","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2818-916X","authenticated-orcid":false,"given":"Elena","family":"De Cristofaro","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Jacques","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheyla","family":"Montori","sequence":"additional","affiliation":[{"name":"Gastroenterology Research Unit, Navarrabiomed; Hospital Universitario de Navarra (HUN); Universidad P\u00fablica de Navarra (UPNA); Instituto de Investigaci\u00f3n Sanitaria de Navarra (IdiSNA); Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timoth\u00e9e","family":"Wallenhorst","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Pontchaillou University Hospital, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Lepilliez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, H\u00f4pital Priv\u00e9 Jean Mermoz, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thibault","family":"Degand","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Dijon University Hospital, Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yann","family":"Le Baleur","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Hospital Saint Joseph, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Leclercq","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, CHC Groupe Sant\u00e9, Li\u00e8ge, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Bordeaux University Hospital, Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edouard","family":"Chabrun","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Clinique de l\u2019Anjou, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertrand","family":"Brieau","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Cliniques Jules Verne, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilien","family":"Barret","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Cochin University Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9311-3746","authenticated-orcid":false,"given":"Eduardo","family":"Alb\u00e9niz","sequence":"additional","affiliation":[{"name":"Gastroenterology Research Unit, Navarrabiomed; Hospital Universitario de Navarra (HUN); Universidad P\u00fablica de Navarra (UPNA); Instituto de Investigaci\u00f3n Sanitaria de Navarra (IdiSNA); Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Rahmi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Georges Pompidou European Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Legros","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00f4me","family":"Rivory","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, H\u00f4pital Edouard Herriot, Hospices Civils de Lyon, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Leblanc","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, H\u00f4pital Priv\u00e9 Jean Mermoz, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2251-9076","authenticated-orcid":false,"given":"Geoffroy","family":"Vanbiervliet","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Nice University Hospital, Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Albouys","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, 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