Evidence map›Paper›PMID 40553399›Full record

ArticleDigestive diseases and sciences2025

Prophylactic Rectal ESD (Endoscopic Submucosal Dissection) Defect Closure and Post-ESD Clinical Outcomes: An International Multi-Center Study (with Video).

Anand R Kumar, Pranita Madaka, Joria Le, Reygenald D Ines, Celestina Tolosa, Saowanee Ngamruengphong, Fiona Milne, Robert Bechara, Jonathan Steinberg, Lionel S D'Souza and 17 more

Abstract readMulticenter StudyVideo-Audio Media
PubMed Full text at PMC Publisher
In one paragraph

Article in Digestive diseases and sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Anand R KumarDivision of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Anand.Kumar@jefferson.edu.ORCID http://orcid.org/0000-0002-4339-2353
Pranita MadakaDrexel University, Philadelphia, PA, USA.
Joria LeDivision of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Reygenald D InesJohns Hopkins University, Baltimore, MD, USA.
Celestina TolosaDivision of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA.
Saowanee NgamruengphongDivision of Gastroenterology & Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA.
Fiona MilneDivision of Gastroenterology, Kingston Health Sciences Center, Queen's University, Kingston Ontario, Canada.
Robert BecharaDivision of Gastroenterology, Kingston Health Sciences Center, Queen's University, Kingston Ontario, Canada.
Jonathan SteinbergDivision of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, NY, USA.
Lionel S D'SouzaDivision of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, NY, USA.
Frances DangDivision of Gastroenterology, University of California Irvine, Orange, CA, USA.
Jason SamarasenaDivision of Gastroenterology, University of California Irvine, Orange, CA, USA.
Galen LeungDivision of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.
Laura LucaciuInstitute for Liver & Digestive Health, UCL (University College London), The Royal Free Hospital, London, UK.
Edward John DespottInstitute for Liver & Digestive Health, UCL (University College London), The Royal Free Hospital, London, UK.
Federico BarbaroDigestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, and Center for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy.
Michele ChiappettaDigestive Endoscopy Unit, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy.
Sumant InamdarDivision of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Rahul KarnaDivision of Gastroenterology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA.
Mohammad BilalDivision of Gastroenterology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA.
Yutaka TomizawaDivision of Gastroenterology, University of Washington, Seattle, WA, USA.
Amer AlsammanDivision of Gastroenterology, University of California Davis, Davis, CA, USA.
Antonio Mendoza LaddDivision of Gastroenterology, University of California Davis, Davis, CA, USA.
Yasi XiaoDivision of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Faisal KamalDivision of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Alexander SchlachtermanDivision of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Thomas KowalskiDivision of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeProphylactic endoscopic submucosal dissection (ESD) defect closure has been suggested to reduce delayed adverse events (DAE) associated with ESD but the data are limited. We aim to study the effect of prophylactic rectal ESD defect closure on post-ESD outcomes.

methodsAn international multicenter retrospective cohort study was performed between 2016 and 2023 involving patients who underwent rectal ESD without intraprocedural perforations and had follow-up data available for at least 2 weeks post-ESD. Delayed adverse events (DAE) defined as bleeding and perforation within 2 weeks of ESD and post-procedure hospitalization or observation rates were compared between the two groups - ESD defects closed (closure group) and ESD defects open (open group).

resultsA total of 385 patients were included. Complete closure of ESD defects was performed in 166 (43%) patients. DAE were observed in 21 (5.5%) patients. On logistic regression analysis, anticoagulant use, NICE3 lesions and incomplete resections had significantly higher rate of DAE. In these high-risk groups, defect closure had a numerically lower rate of DAE without statistical significance. While defect closure did not significantly reduce the rate of overall DAE (p = 0.16), there were no delayed perforations in the closure group compared to 3 (1.3%) in the open group. A significantly lower number of patients were kept for post-ESD overnight hospital observation in the closure group compared to the open group (17% v 37%, p < 0.01).

conclusionsProphylactic closure of rectal ESD defects leads to significantly less overnight hospital observation. Anticoagulant use, NICE 3 lesions and incomplete resections had significantly higher DAE within 2 weeks. While defect closure did not significantly reduce the overall DAE, selective prophylactic defect closure in high-risk groups will need to be studied in larger samples.

Indexed as

Endoscopic Mucosal ResectionPostoperative ComplicationsRectal NeoplasmsWound Closure TechniquesAgedFemaleHumansMaleMiddle AgedRetrospective StudiesTreatment OutcomeBleedingComplicationsDefect ClosureESDLength of Stay (LOS)OverstitchPerforationRectum

Identifiers

PMID40553399
PMCPMC12627156

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.