Modified coagulation and clipping method for the prevention of post‑operative bleeding after gastric endoscopic submucosal dissection: A multicenter propensity score matching analysis

The prevention of post‑operative bleeding is currently a critical issue associated with endoscopic submucosal dissection (ESD), where combined anti‑thrombotic therapy is the standard in a super‑aged society. Post‑ESD coagulation (PEC) is widely performed to prevent post‑operative bleeding; nonetheless, post‑operative bleeding rates associated with gastric ESD continue to be reported in 3.1‑5.5% of cases. The present study aimed to examine the effectiveness of a novel technique, the modified coagulation and clipping (MCC) method, in preventing post‑operative bleeding associated with ESD. Overall, 481 patients were treated between April, 2007 and July, 2020. Between July, 2010 and June, 2020, the MCC method was adopted. The incidence of post‑operative bleeding was assessed following gastric ESD and the clinical conditions affecting post‑operative bleeding during this period were analyzed retrospectively. In addition, the incidence of post-operative bleeding associated with gastric ESD and the clinical conditions in the 3‑year period from April, 2007 to June, 2010 were assessed, during which PEC was employed, as a historical control. The bleeding rates for these two periods were compared using propensity score matching (PSM). Of the 481 included patients, 160 and 321 patients underwent the PEC and MCC method, respectively. In total, 9 patients (5.6%) in the PEC group developed post‑operative bleeding, whereas no patient (0.0%) in the MCC group developed post‑operative bleeding. The PSM analysis revealed that the MCC method was significantly associated with the prevention of post‑operative bleeding. On the whole, the findings of the present study indicate that the MCC method is a promising technique for preventing post‑operative bleeding associated with ESD. However, further studies are required to identify the optimal indications.