Post written by Takaya Shimura, MD, PhD, from the Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.

The aim of this RCT (CliPEC study) is to assess the usefulness of endoscopic clipping closure to prevent Post-ESD coagulation syndrome (PECS) and delayed perforation. In addition, another aim is to clarify the actual situation of PECS. It was assessed by routine CT scan for all participants after colorectal ESD.

Post-ESD coagulation syndrome occasionally occurs following colorectal ESD. PECS reveals localized abdominal pain, fever, and inflammation after ESD; however, exact cause and epidemiology remain unknown because there are a few prospective studies related to PECS. Actually, it is impossible to assess abdominal pain retrospectively due to lack of objectivity.

A previous RCT reported the usefulness of clipping closure to prevent post-polypectomy coagulation syndrome; however, no RCT has been conducted for PECS after colorectal ESD so far.

The present study added 5 novel pieces of information to the existing knowledge:

1. Clipping closure after colorectal ESD does not reduce the incidence of PECS.
2. Simple peri-luminal air without abdominal pain and inflammation occasionally occurs after colorectal ESD.
3. Peri-luminal air with abdominal pain and inflammation should be categorized into PECS, not into delayed perforation. We classified PECS into 2 types: type I PECS, conventional PECS without extra-luminal air; type II PECS, PECS with peri-luminal air.
4. Right-sided colon including cecum and ascending colon appears to be a risk factor for the incidence of PECS, as previously reported.
5. Colorectal ESD is safely manageable in a clinical practice.

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