{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:17:59Z","timestamp":1791231479156,"version":"4.1.0"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"name":"Italian Society of Digestive Endoscopy","award":["Research Grant 2023"],"award-info":[{"award-number":["Research Grant 2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Third-space endoscopy is standard practice for neoplastic and motility disorders; however, it carries a high risk of intraprocedural bleeding. Such risk may be reduced by prophylactic coagulation of submucosal vessels, but this requires instrument exchange. A new approach involves pre-sealing submucosal vessels under saline immersion using standard electrocautery settings and the same knife.<\/jats:p>\n                  <jats:p>Patients undergoing third-space procedures (endoscopic submucosal dissection or peroral endoscopic myotomy) were randomized to receive either targeted saline-immersion pre-sealing (intervention group) or conventional coagulation (carbon dioxide insufflation, control group) for prophylactic management of vessels \u22651.2 mm. Dissection settings were identical. Rate of per-patient intraprocedural bleeding requiring re-treatment for vessels \u22651.2 mm was the main outcome. Per-vessel analyses were also performed. The use of an adjunctive device and coagulation time were also assessed.<\/jats:p>\n                  <jats:p>70 patients (37 immersion, 33 control) with 864 \u22651.2-mm vessels were included. Saline-immersion pre-sealing significantly reduced bleeding rates: per patient (32.4% vs. 75.8%; relative risk [RR] 0.43, 95%CI 0.26\u20130.71; number needed to treat [NNT] 2.3; P &lt; 0.01); per vessel (6.3% vs. 29.9%; RR 0.21, 95%CI 0.14\u20130.31; NNT 4.2; P &lt; 0.01). Use of coagulation forceps for bleeding treatment also decreased (0% vs. 24.2% and 0% vs. 8.3%; P &lt; 0.01). A significant reduction in mean (SD) coagulation time was reported in the saline-immersion group (22.7 [26.4] vs. 29.6 [49.8] seconds; P &lt; 0.01).<\/jats:p>\n                  <jats:p>A substantial reduction in the risk of intraprocedural bleeding was achieved by saline-immersion pre-sealing in per-patient and per-vessel analyses, prompting its implementation in clinical practice.<\/jats:p>","DOI":"10.1055\/a-2780-5445","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T23:53:01Z","timestamp":1767657181000},"page":"608-615","source":"Crossref","is-referenced-by-count":5,"title":["Vessel coagulation in third-space endoscopy: a randomized controlled trial"],"prefix":"10.1055","volume":"58","clinical-trial-number":[{"clinical-trial-number":"nct05804266","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2212-2266","authenticated-orcid":false,"given":"Antonio","family":"Capogreco","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Gastroenterology, Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Maselli","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Gastroenterology, Endoscopy Unit"]},{"name":"Humanitas University, Italy","place":["Pieve Emanuele"],"department":["Department of Biomedical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Massimi","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Gastroenterology, Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovico","family":"Alfarone","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Gastroenterology, Endoscopy Unit"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-2649","authenticated-orcid":false,"given":"Roberto","family":"de Sire","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Gastroenterology, Endoscopy Unit"]},{"name":"Federico II University Hospital, Italy","place":["Naples"],"department":["IBD Unit, Department of Clinical Medicine and 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