Evaluation of a Modified Coagulation and Clipping Method To Prevent Postoperative Bleeding After Gastric Endoscopic Submucosal Dissection: A Multicenter Study

Postoperative bleeding is one of the most frequent adverse events in endoscopic submucosal dissection (ESD). Post-ESD coagulation (PEC) is widely performed to prevent postoperative bleeding; nonetheless, the postoperative bleeding rate after gastric ESD remains 3.1 - 5.5%. This study aimed to compare postoperative bleeding rates between patients receiving conventional treatment and those receiving the modified coagulation and clipping (MCC) treatment. Overall, 481 patients were treated between April 2007 and July 2020. The PEC method was perfomed from April 2007 to June 2010, whereas the MCC method was performed from July 2010 to July 2020. Clinicopathological characteristics were retrospectively compared between patients who underwent these two methods using univariate analysis and propensity score matching (PSM) analysis. Of the 481 included patients, 160 and 321 underwent PEC and MCC, respectively. Nine patients (5.6%) in the PEC group developed postoperative bleeding, whereas no patient (0.0%) in the MCC group developed postoperative bleeding. The univariate analysis and PSM analysis showed that the MCC method was significantly associated with the prevention of postoperative bleeding. In conclusion, the postoperative bleeding rate is lower with the MCC method than with the conventional method. The MCC method may be beneficial in preventing postoperative bleeding.