Closure of gastric mucosal defects using the reopenable-clip over-the-line method to decrease the risk of bleeding after endoscopic submucosal dissection: a multicenter propensity score–matched case-control study (with video)

Abstract

Background and Aims

Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer. However, post-ESD bleeding presents significant risks. Closing mucosal defects after ESD may reduce the incidence of post-ESD bleeding. Currently, no optimal closure method exists. Therefore, we invented clip-line closure using the reopenable-clip over-the-line method (ROLM) and evaluated its efficacy in preventing post-ESD bleeding.

Methods

We retrospectively reviewed data from patients who underwent gastric ESD between January 2012 and March 2024. Patients were categorized into 2 groups: the nonclosure group (mucosal defect remained unclosed) and the ROLM group (defect was closed using ROLM). Baseline characteristics of patients, distribution of bleeding risk factors, and incidence and timing of post-ESD bleeding were compared between the groups. Propensity score matching was used to minimize potential bias.

Results

After propensity score matching, 162 ESDs were performed for 168 lesions in the nonclosure group, whereas 160 ESDs were performed for 168 lesions in the ROLM group. The mean long diameter of the mucosal defects, procedure time for ROLM, and number of clips required for ROLM were 45.9 mm, 35.6 minutes, and 33.2, respectively. All mucosal defects resulting from the ESD were fully closed using ROLM. The post-ESD bleeding rate in the ROLM group was significantly lower (1.8%; 3 of 168 lesions) than in the nonclosure group (7.7%; 13 of 168 lesions; P = .02).

Conclusions

ROLM is feasible for mucosal defect closure after gastric ESD and effectively prevents post-ESD bleeding in high-risk patients, addressing a significant gap in existing methods.