Background The role of alternate mucosa-submucosa clip in preventing postoperative bleeding following endoscopic submucosal dissection (ESD) for gastric mucosal lesions has rarely been reported; therefore, this study aimed to evaluate the efficacy of this procedure.

Methods Data from 924 patients who underwent ESD for gastric mucosal lesions were retrospectively collected from three hospitals in China and categorized into completely closed groups and unclosed groups based on postoperative wound closure. The incidence of postoperative bleeding, abdominal pain and other adverse events, and postoperative wound healing rate at 1 and 3 months were compared between the groups, and the factors related to delayed bleeding after ESD were analyzed.

Results The rate of delayed hemorrhage was significantly lower in the completely closed group than in the unclosed group (0.8% [4/479] vs. 7.6% [34/445]; P<0.001), and subgroup analysis showed that this effect was consistent across all subgroups. The postoperative abdominal pain score was lower in the completely closed group than in the unclosed group (0 vs. 2, respectively, P<0.001). One month postoperatively, the wound healing rate was significantly higher in the completely closed group than in the unclosed group (77.6% [180/232] vs. 55.1% [118/231]; P<0.001). Multivariate analysis showed that the presence of ulcers or scars on the lesion surface, lesions located in the lower one-third of the stomach, and specimen size were independent risk factors for postoperative bleeding.

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Abstract IDDF2024-ABS-0365 Figure 1

Alternate mucosa submucosa clip method.

Conclusions The application of the alternate mucosa–submucosa clip method (IDDF2024-ABS-0365 Figure 1. Alternate mucosa submucosa clip method) for closing the postoperative wound of ESD for gastric mucosal lesions can reduce the risk of postoperative bleeding, alleviate postoperative abdominal pain, and promote artificial wound healing.