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Page 8 of 13 Shichijo et al. Mini-invasive Surg 2022;6:19 https://dx.doi.org/10.20517/2574-1225.2021.121

Figure 4. (A) Laterally spreading tumor is present in the transverse colon; (B) the specimen is resected en bloc in 33 min; (C) ulcer scar
just after endoscopic submucosal dissection. No muscle injury has been identified; (D) CT scan revealed extraluminal air.

Figure 5. (A) A 3-mm hole in the endoscopic submucosal dissection ulcer was identified, i.e., delayed perforation; (B) over-the-scope
clip was placed after suctioning of the perforation site and surrounding ulcer bed.

procedure, participants were randomly assigned (1:1) to either undergo conventional treatment (non-
antibiotic group) or investigational treatment (antibiotic group). In the antibiotic group, ampicillin-
sulbactam (3 g) was administered just before, 8 h after, and the morning after ESD. From February 5, 2019
to September 7, 2020, 432 patients were registered in total and assigned to antibiotic (n = 216) or non-
antibiotic (n = 216) groups. After excluding 52 patients, 192 in the antibiotic group and 188 in the non-
antibiotic group were analyzed. PECS were identified in 9 (4.7%) of the 192 patients in the antibiotic group
and in 14 (7.5%) of the 188 patients in the non-antibiotic group (odds ratio = 0.61, 95% confidence interval:
0.23-1.56, P = 0.29). Therefore, we concluded that the routine administration of perioperative antibiotics for
colorectal ESD is not recommended.

Several studies have reported the effect of clip closure of ESD ulcers for PECS [41,78] , but the meta-analysis did
not report a preventive effect for PECS .
[64]