{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:39:58Z","timestamp":1790249998889,"version":"4.1.0"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"name":"Associazione Italiana per la Ricerca sul Cancro","award":["Bando PNRR-MCNT2-2023-12377041,IG 2022 -ID. 27843,IG 2023 -ID. 29220"],"award-info":[{"award-number":["Bando PNRR-MCNT2-2023-12377041,IG 2022 -ID. 27843,IG 2023 -ID. 29220"]}]}],"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>Endoscopic submucosal dissection (ESD) is a minimally invasive and effective treatment for large nonpedunculated colorectal polyps; however, it carries a relevant risk of adverse events (AEs), such as delayed bleeding, as well as postprocedural perforation (PPP) and postelectrocoagulation syndrome (PECS). Systematic defect closure may reduce these risks, but its preventive efficacy remains uncertain. We conducted a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of prophylactic clipping after colorectal ESD.<\/jats:p>\n                  <jats:p>Following PRISMA guidelines, we searched MEDLINE, Embase, and SCOPUS through to June 2025 for RCTs comparing prophylactic clipping vs. no clipping after colorectal ESD in adults. The primary outcome was clinically significant delayed bleeding; secondary outcomes included PPP and PECS, as well as subanalysis by location and size. Random-effects models were used to compute risk ratios (RRs) and 95%CIs.<\/jats:p>\n                  <jats:p>Four RCTs from Asia including 684 patients were analyzed (336 with clipping, 348 controls). Prophylactic clipping significantly reduced clinically significant delayed bleeding risk (0.3% vs. 3.4%; RR 0.26, 95%CI 0.08\u20130.88). No significant differences were found for PPP (0.4% vs. 1.0%; RR 0.74; 95%CI 0.23\u20132.35) or PECS (12.2% vs. 11.8%; RR 1.06; 95%CI 0.74\u20131.52). Subgroup analyses by lesion size (&gt;30 mm vs. &lt;30 mm) and location (proximal vs. distal colon) were not significant.<\/jats:p>\n                  <jats:p>A 74% decrease in the risk of clinically significant delayed bleeding is achieved by prophylactic clipping after colorectal ESD, supporting its adoption in routine practice.<\/jats:p>","DOI":"10.1055\/a-2797-9390","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T01:37:09Z","timestamp":1772242629000},"page":"644-653","source":"Crossref","is-referenced-by-count":7,"title":["Prophylactic clipping after colorectal endoscopic submucosal dissection in randomized controlled trials: a systematic review and meta-analysis"],"prefix":"10.1055","volume":"58","author":[{"given":"Ludovico","family":"Alfarone","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Spadaccini","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Rizkala","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-2649","authenticated-orcid":false,"given":"Roberto","family":"deSire","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Massimi","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"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":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-0516","authenticated-orcid":false,"given":"Akihiro","family":"Miyakawa","sequence":"additional","affiliation":[{"name":"Asahi General Hospital, Japan","place":["Asahi"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshio","family":"Kuwai","sequence":"additional","affiliation":[{"name":"Kure Medical Center and Chugoku Cancer Center, Japan","place":["Kure"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzuru","family":"Tamaru","sequence":"additional","affiliation":[{"name":"Kure Medical Center and Chugoku Cancer Center, Japan","place":["Kure"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaya","family":"Shimura","sequence":"additional","affiliation":[{"name":"Nagoya City University Graduate School of Medical Sciences and Medical School, Japan","place":["Nagoya"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taro","family":"Osada","sequence":"additional","affiliation":[{"name":"Juntendo University Urayasu Hospital, Japan","place":["Urayasu"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Kashida","sequence":"additional","affiliation":[{"name":"Kindai University Faculty of Medicine Graduate School of Medical Sciences, Japan","place":["Osaka"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremie","family":"Jacques","sequence":"additional","affiliation":[{"name":"CHU Dupuytren, France","place":["Limoges"],"department":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Bourke","sequence":"additional","affiliation":[{"name":"Westmead Hospital, New South Wales, Australia","place":["Sydney"],"department":["Department of Gastroenterology and Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prateek","family":"Sharma","sequence":"additional","affiliation":[{"name":"University of Kansas School of Medicine and VA Medical Center, Missouri, United States","place":["Kansas City"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Messmann","sequence":"additional","affiliation":[{"name":"University of Augsburg Faculty of Medicine, Germany","place":["Augsburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas K.","family":"Rex","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indiana, United States","place":["Indianapolis"],"department":["Division of Gastroenterology\/Hepatology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Maselli","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Hassan","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]},{"name":"Humanitas University, Italy","place":["Milan"],"department":["Department of Biomedical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Repici","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Italy","place":["Rozzano"],"department":["Department of Gastroenterology and Endoscopy"]},{"name":"Humanitas University, Italy","place":["Milan"],"department":["Department of Biomedical Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"29","DOI":"10.7326\/M23-1812","article-title":"Endoscopic en bloc versus piecemeal resection of large nonpedunculated colonic adenomas: a randomized comparative trial","volume":"177","author":"J Jacques","year":"2024","journal-title":"Ann Intern Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1016\/j.gie.2010.08.004","article-title":"A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video)","volume":"72","author":"Y Saito","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"370","DOI":"10.14309\/ajg.0000000000002952","article-title":"Impact of annual case volume on colorectal endoscopic 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Open"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2797-9390.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T22:30:59Z","timestamp":1779402659000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2797-9390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":26,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2026,5,21]]},"published-print":{"date-parts":[[2026,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2797-9390","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]}}}