{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:03:42Z","timestamp":1784160222085,"version":"3.55.0"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background and study aims Delayed post-polypectomy bleeding (DPPB) remains a significant adverse event following colonic endoscopic resection. Although complete defect closure may reduce bleeding risk, it is often technically challenging. We evaluated the feasibility and safety of a targeted in-defect clipping strategy that does not aim for complete closure.<\/jats:p>\n                  <jats:p>Patients and methods We conducted a prospective feasibility cohort study of consecutive adult patients undergoing colonic endoscopic resection of lesions \u226530 mm, followed by targeted in-defect clipping (iCLIP) with 3\u20134 endoclips. Eligible cases involved defects in which complete closure was difficult. The primary endpoint was feasibility, defined as successful deployment of 3\u20134 clips in \u226590% of cases. Secondary endpoints included DPPB, delayed perforation, post-polypectomy syndrome and post-procedural pain within 30 days.<\/jats:p>\n                  <jats:p>Results A total of 100 patients were included. Lesions were predominantly right-sided (73%) with a median size of 35 mm. EMR and ESD were performed in 71% and 29% of cases, respectively. The iCLIP strategy was successfully performed in 99% of cases, with one episode of delayed bleeding. No delayed perforation was observed. Post-polypectomy syndrome occurred in one patient and post-procedural pain in eight patients.<\/jats:p>\n                  <jats:p>Conclusions Targeted in-defect clipping using 3\u20134 endoclips appears to be a feasible and safe approach for management of challenging post-resection defects and was associated with a very low rate of delayed bleeding in this pilot cohort.<\/jats:p>","DOI":"10.1055\/a-2905-7370","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T23:18:22Z","timestamp":1783034302000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Targeted In-Defect Clipping After Colonic Endoscopic Resection: A Prospective Feasibility Study"],"prefix":"10.1055","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0702-190X","authenticated-orcid":false,"given":"George","family":"Tribonias","sequence":"additional","affiliation":[{"name":"General Hospital Korgialenio-Benakio Red Cross, Attica, Greece","place":["Athens"],"department":["Gastroenterology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3494-2311","authenticated-orcid":false,"given":"Petros","family":"Zormpas","sequence":"additional","affiliation":[{"name":"General Hospital Korgialenio-Benakio Red Cross, Attica, Greece","place":["Athens"],"department":["Gastroenterology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5071-6080","authenticated-orcid":false,"given":"Marianna","family":"Spinou","sequence":"additional","affiliation":[{"name":"General Hospital Korgialenio-Benakio Red Cross, Attica, Greece","place":["Athens"],"department":["Gastroenterology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0068-8461","authenticated-orcid":false,"given":"Yoriaki","family":"Komeda","sequence":"additional","affiliation":[{"name":"Kindai University Faculty of Medicine Hospital, Japan","place":["Osaka-Sayama"],"department":["Gastroenterology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9472-519X","authenticated-orcid":false,"given":"Antonis","family":"Pikoulas","sequence":"additional","affiliation":[{"name":"General Hospital Korgialenio-Benakio Red Cross, Attica, Greece","place":["Athens"],"department":["Gastroenterology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita-Eleni","family":"Manola","sequence":"additional","affiliation":[{"name":"General Hospital Korgialenio-Benakio Red Cross, Attica, Greece","place":["Athens"],"department":["Gastroenterology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6501-1486","authenticated-orcid":false,"given":"Eleni","family":"Nakou","sequence":"additional","affiliation":[{"name":"General Hospital Korgialenio-Benakio Red Cross, Attica, Greece","place":["Athens"],"department":["Gastroenterology Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/gutjnl-2014-308481","article-title":"Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis","volume":"65","author":"C Hassan","year":"2016","journal-title":"Gut"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"651.e1-3","DOI":"10.1016\/j.cgh.2013.09.049","article-title":"Risk factors for intraprocedural and clinically significant delayed bleeding after wide-field endoscopic mucosal resection of large colonic lesions","volume":"12","author":"N G Burgess","year":"2014","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"11","key":"ref3","doi-asserted-by":"crossref","first-page":"1814","DOI":"10.1136\/gutjnl-2024-334463","article-title":"Prophylactic clip closure after endoscopic submucosal dissection of large flat and sessile colorectal polyps: a multicentre randomised controlled trial (EPOC trial)","volume":"74","author":"A Miyakawa","year":"2025","journal-title":"Gut"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1111\/jgh.16722","article-title":"Closure methods for large defects after gastrointestinal endoscopic submucosal dissection","volume":"39","author":"R Gong","year":"2024","journal-title":"J Gastroenterol Hepatol"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1016\/j.gie.2023.01.005","article-title":"Modified double-layered suturing for a mucosal defect after colorectal endoscopic submucosal dissection (origami method) (with video)","volume":"97","author":"T Masunaga","year":"2023","journal-title":"Gastrointest Endosc"},{"issue":"09","key":"ref6","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1136\/gutjnl-2021-325184","article-title":"Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update","volume":"70","author":"A M Veitch","year":"2021","journal-title":"Gut"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"728704","DOI":"10.3389\/fmed.2021.728704","article-title":"Endoscopic Management of Complex Colorectal Polyps: current insights and future trends","volume":"20","author":"R Mann","year":"2022","journal-title":"Front Meds"},{"issue":"14","key":"ref8","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2147\/CEG.S282699","article-title":"Delayed bleeding after endoscopic resection of colorectal polyps: identifying high-risk patients","volume":"24","author":"O Bendall","year":"2021","journal-title":"Clin Exp Gastroenterol"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1053\/j.gastro.2020.03.051","article-title":"Prophylactic clipping after colorectal endoscopic resection prevents bleeding of large, proximal polyps: meta-analysis of randomized trials","volume":"159","author":"M Spadaccini","year":"2020","journal-title":"Gastroenterology"},{"issue":"11","key":"ref10","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1055\/a-2637-3180","article-title":"The effect of prophylactic clipping on delayed bleeding after proximal colonic endoscopic mucosal resection: a multicenter, randomized controlled trial (CLIPPER)","volume":"57","author":"G Kemper","year":"2025","journal-title":"Endoscopy"}],"container-title":["Endoscopy International 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