Should routine coagulation of visible vessels be performed after endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a revolutionary procedure that allows for en bloc resection of large tumors in the gastrointestinal tract; however, complications can occur including perforation and bleeding. In this Practice Point commentary, we discuss the findings and limitations of a retrospective study conducted by Takizawa and colleagues that investigated risk factors for delayed bleeding in patients with gastric cancer who underwent ESD. The findings of their study suggest that preventative electrocoagulation of nonbleeding visible vessels after ESD might reduce the incidence of delayed bleeding. In addition, tumor location was found to influence the rate of delayed bleeding. This commentary highlights the issues to consider when interpreting these findings in clinical practice, and we consider the resonance of these results for ESD of colorectal tumors.