Impact of swift versusspray coagulation on procedural outcomes in colorectal endoscopic submucosal dissection

Aims: Endoscopic submucosal dissection (ESD) is an established technique for the curative resection of large colorectal lesions; however, intraoperative bleeding remains a major technical challenge. Electrosurgical coagulation modes are modifiable procedural factors that may influence bleeding control and procedural efficiency. This study aimed to compare the clinical outcomes of Swift and Spray coagulation modes during colorectal ESD. Methods: This retrospective, single-center study included 594 consecutive patients who underwent colorectal ESD between January 2021 and December 2025. Patients were divided into the Spray and Swift coagulation groups according to the coagulation mode used during submucosal dissection. Procedural characteristics, intraoperative and delayed bleeding, perforation rates, and other adverse events were analyzed and compared between groups. Results: Baseline patient and lesion characteristics were comparable between the two groups. The mean procedure time was significantly shorter in the Spray coagulation group compared with the Swift coagulation group (42.2±23.7 vs 51.7±31.9 minutes, p