Post written by Yoji Takeuchi, MD, FJGES, from the Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

Post—endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) sometimes occurs after colorectal ESD and leads to extended hospitalization. Although the efficacy of perioperative antibiotics preventing PECS had been uncertain, perioperative antibiotics had been used to prevent PECS according to circumstances.

We conducted the first prospective, multicenter, randomized controlled, parallel, superiority trial, which examined the efficacy of perioperative antibiotics in preventing PECS.

First, because we have used perioperative antibiotics to prevent PECS without clear evidence, we wanted to make it clear. Second, colorectal ESD is one of the most technically challenging and unclean endoscopic procedures. Then, we can apply our results to other less complicated and unsanitary procedures.

Finally, colorectal ESD is still not standard outside Asian countries, but it is already a common procedure for us. Because this is the first multicenter, prospective, randomized controlled trial on colorectal ESD, we thought our study, with its prospective nature of a large number of participants, provides a real clinical course of patients undergoing colorectal ESD.

PECS occurred in 9 out of 192 (4.7%) patients in the antibiotic group and 14 out of 188 (7.5%) patients in the non-antibiotic group, with an odds ratio of 0.61 (95% confidence interval: .23-1.56, P = .29). Therefore, we never recommend routine use of prophylactic antibiotics for colorectal ESD.

However, once PECS occurred, the period from ESD to PECS (.67 days vs 1.21, P = .01) and the period from ESD to oral intake (1.67 days vs 2.50, P = .03) were significantly shorter in the antibiotics group. Therefore, it might be better to prescribe antibiotics after the occurrence of PECS as soon as possible or to limit the use of perioperative antibiotics for the high-risk patients of PECS.

ESD was developed in Japan and is gradually expansive, spreading worldwide. We are delighted to support standardized periprocedural management of colorectal ESD.

Study flow. ITT, Intention to treat; FAS, full analysis set; PPS, per-protocol set; ESD, endoscopic submucosal dissection.

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