Anticoagulation in colorectal ESD: implications for bleeding risk management

We read with great interest the recent multicentre randomised controlled trial (RCT) by Miyakawa et al,1 which demonstrated a significant reduction in delayed bleeding after colorectal endoscopic submucosal dissection (ESD) through prophylactic clip closure. The authors are to be commended for conducting the first RCT powered to assess delayed bleeding as a primary endpoint and for showing significant benefit in both overall (6.7% vs 20.1%) and severe bleeding rates (1.3% vs 8.7%).