Prophylactic Rectal ESD (Endoscopic Submucosal Dissection) Defect Closure and Post-ESD Clinical Outcomes: An International Multi-Center Study (with Video)
Bibliographic record
Abstract
PURPOSE: Prophylactic 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. METHODS: An 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). RESULTS: A 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). CONCLUSIONS: Prophylactic 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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".