Feasibility, Stability, and Clinical Outcomes of Mucosal Defect Closure Using a Novel Hooking-Jaw Clip after Gastric Endoscopic Submucosal Dissection

Background and study aims: Clipping is a simple conventional closure technique for gastric endoscopic submucosal dissection (ESD) defects. This study evaluated the technical feasibility and stability of mucosal defect closure using a novel hooking-jaw clip. In addition, we assessed the safety outcomes compared with a non-closure group. Patients and methods: This single-center retrospective pilot study assessed technical success (complete closure, ≥ 90% area reduction) and closure stability during second-look endoscopy (SLE) on postoperative day 1 in 41 patients. We compared the secondary outcomes with a non-closure group using propensity score matching (PSM) (n = 41 per group). Secondary outcomes included incidences of delayed bleeding and frequency of hemostatic interventions during SLE. Results: Hooking-jaw clip-closure achieved technical success in 92.7% (38/41) of patients; partial closure (50%–89% area reduction) occurred in 7.3% (3/41), and no closure failure (<50%) occurred. The median closure time was 10.0 minutes. Closure remained stable in 87.8% (36/41) of patients at SLE. After PSM, the delayed bleeding rate was 0.0% (0/41) in the closure group and 4.9% (2/41) in the non-closure group (P = 0.494). The closure group required a lower rate of hemostatic interventions during SLE (24.4% [10/41] vs. 58.5% [24/41]; P = 0.003). Conclusions: Hooking-jaw clip-assisted closure of gastric ESD defects is technically feasible and maintains stability. Closing reduced the frequency of hemostatic interventions during SLE. Given current guidelines that conditionally recommend omitting routine SLE, stable closure provides a physical rationale to support this practice. Future trials should evaluate this strategy for high-risk populations.