Closure of gastric mucosal defects using the reopenable-clip over-the-line method to decrease the risk of bleeding...

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is a key treatment for early gastric cancer.
• Post-ESD bleeding is a significant complication, with no optimal closure method currently available.
• Effective mucosal defect closure after ESD is crucial for reducing bleeding incidence.

Purpose of the Study:

• To evaluate the efficacy of a newly developed clip-line closure method, the reopenable-clip over-the-line method (ROLM).
• To assess ROLM's ability to prevent post-ESD bleeding.
• To address the unmet need for an optimal mucosal closure technique after gastric ESD.

Main Methods:

• Retrospective review of patients undergoing gastric ESD between January 2012 and March 2024.
• Comparison of a nonclosure group with a group treated using ROLM for mucosal defect closure.
• Propensity score matching to control for baseline characteristics and bleeding risk factors.

Main Results:

• After propensity score matching, 168 lesions were analyzed in both the nonclosure and ROLM groups.
• The post-ESD bleeding rate was significantly lower in the ROLM group (1.8%) compared to the nonclosure group (7.7%; P = .02).
• ROLM successfully achieved complete closure of mucosal defects following ESD.

Conclusions:

• The reopenable-clip over-the-line method (ROLM) is a feasible technique for mucosal defect closure after gastric ESD.
• ROLM effectively prevents post-ESD bleeding, particularly in high-risk patients.
• This method addresses a critical gap in current endoscopic submucosal dissection management.