Scandinavian journal of gastroenterology · 2026
The usefulness of endoscopic closure of the ulcer floor following endoscopic submucosal dissection of the stomach.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Yasuda Takeshi, Ozawa Reo, Toda Sakiko, Sai Yasuyuki, Nishimura Hinako, Tohori Kyohei, Kanai Yoshiaki, Sakamoto Yoichi, Okada Shinji, Endo Yuki, Akazawa Takako, Matsumoto Tsuguhiro, Yamauchi Norihito, Muramatsu Akira, Kutsumi Hiromu
Аннотация
BACKGROUND AND AIM: Bleeding and perforation remain major complications after gastric endoscopic submucosal dissection (ESD). Simple clip-based closure techniques, including the reopenable-clip over-the-line method (ROLM) and the ORIGAMI method, have recently been developed in Japan, but clinical evidence supporting their use is limited. This study evaluated the feasibility and clinical effectiveness of post-ESD gastric ulcer closure using these techniques in a community hospital.
METHODS: This single-center retrospective study included patients who underwent gastric ESD between April 2021 and October 2025. Patients treated from May 2023 onward who received endoscopic closure using ROLM or the ORIGAMI method were assigned to the closure group, while those treated earlier without closure comprised the non-closure group. The primary endpoint was ESD-related adverse events within 14 days, including delayed bleeding and perforation. The secondary endpoints were suturing time, number of clips used, and postoperative hospital stay.
RESULTS: A total of 137 patients were analyzed (closure group, n = 51; non-closure group, n = 86). Baseline characteristics, including bleeding risk assessed by the BEST-J score, were comparable between groups. The incidence of delayed bleeding or perforation was significantly lower in the closure group than in the non-closure group (2.0% vs. 12.8%, p = 0.0317), and no delayed bleeding occurred in the closure group. Postoperative hospital stay was significantly shorter in the closure group. Endoscopic closure was successfully achieved in nearly all patients using either technique.
CONCLUSIONS: Prophylactic closure of gastric ulcers after ESD using ROLM or ORIGAMI with standard clips is feasible in community hospitals and reduces post-ESD complications and hospital stay.
METHODS: This single-center retrospective study included patients who underwent gastric ESD between April 2021 and October 2025. Patients treated from May 2023 onward who received endoscopic closure using ROLM or the ORIGAMI method were assigned to the closure group, while those treated earlier without closure comprised the non-closure group. The primary endpoint was ESD-related adverse events within 14 days, including delayed bleeding and perforation. The secondary endpoints were suturing time, number of clips used, and postoperative hospital stay.
RESULTS: A total of 137 patients were analyzed (closure group, n = 51; non-closure group, n = 86). Baseline characteristics, including bleeding risk assessed by the BEST-J score, were comparable between groups. The incidence of delayed bleeding or perforation was significantly lower in the closure group than in the non-closure group (2.0% vs. 12.8%, p = 0.0317), and no delayed bleeding occurred in the closure group. Postoperative hospital stay was significantly shorter in the closure group. Endoscopic closure was successfully achieved in nearly all patients using either technique.
CONCLUSIONS: Prophylactic closure of gastric ulcers after ESD using ROLM or ORIGAMI with standard clips is feasible in community hospitals and reduces post-ESD complications and hospital stay.