The Hedgehog Method Following Gastric Endoscopic Submucosal Dissection: Observed Postoperative Bleeding Rates Across...

Postoperative bleeding remains an important complication after gastric endoscopic submucosal dissection (ESD). We previously reported a modified coagulation and clipping technique, termed the Hedgehog method. However, postoperative bleeding rates across BEST-J risk categories remain unclear.

To evaluate postoperative bleeding rates after gastric ESD using the Hedgehog method according to BEST-J risk categories.

This retrospective single-center study included 259 patients who underwent gastric ESD using the Hedgehog method. Patients were classified according to the BEST-J score, and postoperative bleeding rates with exact 95% confidence intervals (CIs) were calculated using the Clopper-Pearson method.

The median age was 78 years (IQR, 73-82), and 176 patients (68.0%) were male. BEST-J risk categories were low in 185 patients, intermediate in 31, high in 32, and very high in 11. Postoperative bleeding occurred in 3/259 patients (1.2%), all in the low-risk group (3/185, 1.6%; 95% CI, 0.3-4.7%). No bleeding occurred in the intermediate-risk (0/31; 95% CI, 0-11.2%), high-risk (0/32; 95% CI, 0-10.9%), or very-high-risk groups (0/11; 95% CI, 0-28.5%). All three bleeding lesions were located in the antrum, and none of the patients received antithrombotic therapy. Bleeding occurred on days 2, 6, and 2, respectively. All three cases were successfully treated by endoscopic hemostasis, and no delayed perforations occurred.

Low postoperative bleeding rates were observed after gastric ESD using the Hedgehog method. Given the absence of a contemporaneous control group and the small number of bleeding events, these findings require confirmation in controlled studies.