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)

Shinya Sugimoto; Tatsuma Nomura; Taishi Temma; Emika Sawa; Keita Omae; Nobuyuki Tsuda; Ayako Okuda; Hirofumi Okuda; Mayu Kawabata; Ryutaro Matsushima; Haruka Nakamura; Hirohisa Hisada; Satoshi Hayashi; Toji Murabayashi; Jun Oyamada; Akira Kamei; Hayato Nakagawa

doi:10.1016/j.gie.2024.11.015

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)

Gastrointest Endosc. 2024 Nov 12:S0016-5107(24)03696-4. doi: 10.1016/j.gie.2024.11.015. Online ahead of print.

Authors

Shinya Sugimoto¹, Tatsuma Nomura², Taishi Temma¹, Emika Sawa¹, Keita Omae¹, Nobuyuki Tsuda¹, Ayako Okuda¹, Hirofumi Okuda¹, Mayu Kawabata¹, Ryutaro Matsushima¹, Haruka Nakamura¹, Hirohisa Hisada¹, Satoshi Hayashi¹, Toji Murabayashi¹, Jun Oyamada¹, Akira Kamei¹, Hayato Nakagawa³

Affiliations

¹ Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan.
² Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan; Department of Gastroenterology, Suzuka General Hospital, Suzuka, Japan; Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Japan. Electronic address: m06076tn@icloud.com.
³ Department of Gastroenterology and Hepatology, Mie University Hospital, Japan.

PMID: 39542223
DOI: 10.1016/j.gie.2024.11.015

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 following 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-March 2024. Patients were categorized into two groups: the non-closure 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 employed to minimize potential bias.

Results: Following propensity score-matching, 162 ESDs were performed for 168 lesions in the non-closure 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 min, 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%, 3/168 lesions) than in the non-closure group (7.7%, 13/168 lesions, p = 0.02).

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

Keywords: clip; dissection; endoscopic mucosal resection; gastrointestinal hemorrhage; stomach neoplasms.