Prophylactic wound closure after ESD significantly reduces post-ESD bleeding: stratified and meta-regression analyses by tumor size and rectal proportion.

Po-Feng Huang, Peng-Jen Chen, Tien-Yu Huang, Meng-Chuan Lu, Chi-Wei Yang

Abstract readMeta-AnalysisSystematic Review

In one paragraph

Synthesis in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

5 authors.

Po-Feng HuangDivision of Gastroenterology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.

Peng-Jen ChenDivision of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 114202, Taiwan.

Tien-Yu HuangDivision of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 114202, Taiwan.

Meng-Chuan LuDivision of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 114202, Taiwan.

Chi-Wei YangDivision of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, No. 325, Sec. 2, Chenggong Rd., Neihu District, Taipei City, 114202, Taiwan. youngwayleon@gmail.com.ORCID http://orcid.org/0000-0001-9282-811X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundColorectal endoscopic submucosal dissection (ESD) enables curative resection but carries a risk of delayed bleeding. The efficacy of prophylactic wound closure remains uncertain. We conducted a systematic review and meta-analysis to evaluate closure versus non-closure and identify high-risk subgroups.

methodsFollowing PRISMA 2020 guidelines, databases were searched to September 2025 for randomized and comparative cohort studies of closure after colorectal ESD. Primary outcome was delayed bleeding; secondary outcomes were perforation and post-ESD coagulation syndrome (PECS). Pooled odds ratios (ORs) were estimated using random-effects models, with subgroup and meta-regression analyses.

resultsNine studies (n = 2404) were included. Closure significantly reduced delayed bleeding (OR 0.324, 95% CI 0.172-0.611; I

conclusionsProphylactic closure after colorectal ESD reduces delayed bleeding, particularly in large tumors and rectal lesions, but does not alter perforation or PECS risk. Selective closure in high-risk cases may optimize outcomes.

Indexed as

Colorectal NeoplasmsEndoscopic Mucosal ResectionPostoperative HemorrhageWound Closure TechniquesHumansRectumTumor BurdenColorectal ESDDelayed bleedingMeta-analysisRectal lesionsWound closure

Identifiers

PMID41760933

DOI10.1007/s00464-026-12622-x

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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.