Trial reportGut2025
Prophylactic clip closure after endoscopic submucosal dissection of large flat and sessile colorectal polyps: a multicentre randomised controlled trial (EPOC trial).
Trial report in Gut, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Role of topical self-assembling peptide in preventing delayed bleeding following advanced endoscopic resection: a systematic review and meta-analysis.Surgical endoscopy · 2026Pooled it
- Efficacy of prophylactic hemoclip placement for preventing delayed post-polypectomy bleeding in nonpedunculated colorectal lesions: updated meta-analysis and trial sequential analysis of randomized controlled trials.Surgical endoscopy · 2026Review
- A pilot study on the efficacy of cyanoacrylate glue in preventing post-ESD bleeding at the gastric angle.Surgical endoscopy · 2026Article
- Hybrid endoscopic submucosal dissection-endoscopic mucosal resection of large polyps at the ileocecal valve.VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy · 2026Review
- Endoscopic Closure After Colorectal ESD: A Literature Review and Meta-Analysis on Its Efficacy in Preventing Adverse Events.Diagnostics (Basel, Switzerland) · 2026Review
- Article
- Prophylactic Clip Closure to Prevent Bleeding After Colorectal Endoscopic Submucosal Dissection: A Cost-Effectiveness Study.Clinical and translational gastroenterology · 2026Article
- Article
- A novel "twist-and-drag" loop clip technique for closure of mucosal defects after colorectal endoscopic submucosal dissection.Endoscopy · 2026Article
- Traction Device-Assisted Complete Closure to Prevent Colorectal Post-ESD Coagulation Syndrome.Digestive diseases and sciences · 2026Article
- Review
- Effect of Prophylactic Colon ESD (Endoscopic Submucosal Dissection) Defect Closure on Post-ESD Outcomes: An International Multi-center Retrospective Study.Digestive diseases and sciences · 2026Article
- Endoscopic clip systems for hemostasis and defect closure in gastrointestinal endoscopy.World journal of gastrointestinal endoscopy · 2026Review
- Colorectal Endoscopic Submucosal Dissection and Acute Kidney Injury: A Rare but Clinically Relevant Adverse Event, a Cohort Study of 1537 Patients.Endoscopy international open · 2026Article
- Targeted In-Defect Clipping After Colonic Endoscopic Resection: A Prospective Feasibility Study.Endoscopy international open · 2026Article
- Endoscopic Coagulation with Clipping for Colonic Diverticular Bleeding: A Practical Hemostatic Strategy.Endoscopy international open · 2026Article
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundProphylactic clip closure after endoscopic mucosal resection reduces delayed bleeding in large and proximal colon lesions; however, evidence regarding its effectiveness in colorectal endoscopic submucosal dissection (ESD) is lacking.
objectiveTo compare clinically significant delayed bleeding rates between a clip closure and a control group for flat and sessile 20-50 mm colorectal polyps following ESD.
designA multicentre randomised controlled trial conducted at four Japanese institutions randomly assigned patients to closure or non-closure groups. Significant postprocedural bleeding (haematochezia) was classified as severe (requiring endoscopic haemostasis or blood transfusion in patients with haemoglobin levels <70 g/L or haemorrhagic shock) or mild.
resultsThe closure and control groups comprised 150 and 149 cases in the intention-to-treat (ITT) analysis and 142 and 141 cases in the per-protocol (PP) analysis, respectively. Rates of complete clip closure were 88.7% (ITT) and 93.0% (PP). The ITT analysis revealed delayed bleeding rates of 6.7% and 20.1% (OR: 0.28; 95% CI: 0.13 to 0.60; p<0.001; absolute risk difference (ARD): 13.5%; 95% CI: 5.6% to 20.9%) and severe delayed bleeding rates of 1.3% and 8.7% (OR: 0.14; 95% CI: 0.03 to 0.64; p=0.003; ARD: 7.4%; 95% CI: 2.2% to 12.4%) in the closure and control groups, respectively. These differences were confirmed in the PP analysis. Delayed perforation was not observed, and the post-ESD coagulation syndrome rate was not significantly different between the two groups. Multivariate logistic regression analyses identified prophylactic clip closure as a significant independent preventive factor for both delayed bleeding (OR: 0.22; 95% CI: 0.08 to 0.50; p<0.001) and severe delayed bleeding (OR: 0.22; 95% CI: 0.05 to 0.76; p=0.015).
conclusionsProphylactic clip closure, successfully achieved in approximately 90% of cases, reduced the delayed bleeding rate after resection of colorectal polyps measuring 20-50 mm. TRIAL REGISTRATION NUMBER: UMIN000043675.
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