Prophylactic endoscopic coagulation to prevent delayed post-EMR bleeding in the colorectum: a prospective randomized controlled trial (with videos)

Background and Aims: Post-EMR bleeding (PEB) is the most common adverse event after EMR. However, there are no established endoscopic methods for the prevention of PEB. This study aimed to investigate whether prophylactic endoscopic coagulation (PEC) using coagulation probes reduces the incidence of overall delayed PEB. Methods: We performed a randomized controlled study of patients undergoing EMR for large (≥10 mm) sessile lesions and laterally spreading tumors. Patients were randomized 1:1 to the EMR with coagulation group (n = 285) or EMR (control) group (n = 285). Immediate bleeding during colon EMR or clean-based ulcer after EMR was excluded. Clinically significant PEB was defined as bleeding requiring endoscopic hemostasis, hospitalization, or a decrease in the hemoglobin level >2 g/dL. Results: A total of 569 patients were analyzed. The incidence of overall PEB was significantly lower in the EMR with coagulation group than in the control group (12.6% [36/285] vs 18.7% [53/284], P = .048). However, this was largely because of a reduction in minor bleeding. There was no difference in clinically significant PEB (1.8% [5/285] vs 3.2% [9/284], P = .276). Rectal location was a risk factor associated with overall PEB (odds ratio, 1.256; 95% confidence interval, 1.12-1.41; P < .001). Conclusions: Although this study found reduced PEB with prophylactic cautery of visible vessels, this was largely because of a reduction in minor bleeding with no benefit observed for clinically significant bleeding. Overall, PEB was more frequent with rectal lesions. (Clinical trial registration number: KCT0000779.)