The usefulness of endoscopic closure of the ulcer floor following endoscopic submucosal dissection of the stomach

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: = 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.