The EPOC trial (Prophylactic clip closure after ESD of large flat and sessile polyps) is a multicenter randomized controlled trial conducted to evaluate the effectiveness of prophylactic clip closure in reducing delayed bleeding rates following colorectal endoscopic submucosal dissection (ESD) of flat and sessile polyps measuring 20–50 mm. The trial was conducted across four institutions in Japan and aimed to address the lack of evidence regarding the efficacy of clip...
The EPOC trial (Prophylactic clip closure after ESD of large flat and sessile polyps) is a multicenter randomized controlled trial conducted to evaluate the effectiveness of prophylactic clip closure in reducing delayed bleeding rates following colorectal endoscopic submucosal dissection (ESD) of flat and sessile polyps measuring 20–50 mm. The trial was conducted across four institutions in Japan and aimed to address the lack of evidence regarding the efficacy of clip closure in colorectal ESD, as opposed to endoscopic mucosal resection (EMR), where its benefits are better established.
### Key Details of the EPOC Trial:
#### **Objective:**
To compare the clinically significant delayed bleeding rates between a prophylactic clip closure group and a control group following ESD for colorectal polyps.
#### **Design:**
#### **Primary Endpoint:**
The delayed bleeding rate after colorectal ESD.
#### **Secondary Endpoints:**
#### **Results:**
1. **Delayed Bleeding Rates:**
2. **Severe Delayed Bleeding Rates:**
3. **Multivariate Analysis:**
4. **Other Findings:**
#### **Conclusion:**
Prophylactic clip closure significantly reduced delayed bleeding rates following colorectal ESD for polyps measuring 20–50 mm. It was recommended as a preventive measure to improve safety outcomes in colorectal ESD procedures.
#### **Implications for Practice and Policy:**
The study supports the adoption of prophylactic clip closure as a standard practice after colorectal ESD to mitigate the risk of delayed bleeding, which is a common and serious complication.
Introduction: Endoscopic metabolic therapies have emerged as less invasive alternatives to bariatric surgery for patients with obesity and poorly controlled type 2 diabetes mellitus (T2DM). The EndoBarrier duodenal-jejunal bypass liner (DJBL) is an endoscopically placed...
Introduction: Endoscopic ultrasound (EUS)-guided transmural drainage is the standard minimally invasive treatment for symptomatic necrotizing pancreatitis. However, the optimal timing of direct endoscopic necrosectomy (DEN) following drainage remains uncertain. While the conventional step-up approach reserves...
Introduction: Bevacizumab is widely used in metastatic colorectal cancer (mCRC) because of its survival benefits but is associated with impaired wound healing, gastrointestinal perforation, and bleeding. These concerns often lead clinicians to delay endoscopic procedures...
Introduction: Endoscopic submucosal dissection (ESD) enables en bloc resection of large colorectal neoplasms with excellent oncological outcomes. However, concerns about perforation have limited its widespread adoption. This large prospective multicenter study evaluated the incidence, risk...
Introduction: Obesity has become one of the greatest global health challenges. New incretin-based therapies—including semaglutide, tirzepatide, resmetirom, and SGLT2 inhibitors such as empagliflozin—have transformed the treatment of obesity, diabetes, and MASLD. However, many patients discontinue...
Introduction: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is the standard technique for diagnosing solid pancreatic lesions. Traditionally, biopsy specimens are processed for cytology, often requiring on-site cytopathology support. This multicenter prospective study evaluated whether directly placing...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.