Impact of Swift Versus Spray Coagulation on Procedural Outcomes in Gastric Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is an established curative treatment for early gastric neoplasms; however, procedure-related bleeding remains a frequent and clinically significant complication. Electrosurgical settings, particularly the choice of coagulation mode, represent potentially modifiable procedural factors that may influence bleeding control and procedure efficiency during gastric ESD. The current study aimed to compare procedure time and procedure related complications, particularly bleeding, between spray coagulation and swift coagulation modes in patients undergoing gastric ESD.

This single-center retrospective cohort study included 194 patients who underwent gastric ESD between 2021 and 2025. Patients were divided into 2 groups according to the electrosurgical coagulation mode used during the procedure: spray coagulation (n = 113) and swift coagulation (n = 81). Procedure time, intraprocedural and delayed bleeding, use of hemostatic forceps, perforation, post-ESD electrocoagulation syndrome (PECS), recurrence, and stricture formation were analyzed and compared between groups.

Procedure time was significantly shorter in the spray coagulation group compared with the swift coagulation group (38.2 ± 20.7 vs. 44.4 ± 19.1 minutes; P = .0003). Overall intraprocedural bleeding occurred less frequently in the spray coagulation group (44.2% vs. 75.3%; P < .001), and the need for hemostatic forceps was significantly reduced. Severe bleeding events were rare and comparable between groups. Rates of perforation, delayed bleeding, PECS, recurrence, and stricture formation did not differ significantly between groups. Procedural success rates were high and comparable between the groups (93.8% in both groups; P = .99). Similarly, en bloc resection rates (92.9% vs. 92.6%; P = .94) and complete (R0) resection rates (91.2% vs. 91.4%; P = .97) were comparable between the spray and swift coagulation groups.

Spray coagulation during gastric ESD is associated with improved bleeding control and shorter procedure time compared with swift coagulation, without increasing procedure-related complications. Optimization of electrosurgical coagulation mode may enhance procedural efficiency and safety during gastric ESD. Cite this article as: Bas B, Küçükdemirci Ö, Kandemir A, et al. Impact of swift versus spray coagulation on procedural outcomes in gastric endoscopic submucosal dissection. Turk J Gastroenterol. 2026;37(8):847-857.