Evaluation of Delayed Bleeding Prevention and Sustained Closure Using the Reopenable Clip‐Over‐the‐Line Method for Gastric Endoscopic Submucosal Dissection

Objectives: Delayed bleeding is a major complication of gastric endoscopic submucosal dissection (ESD), particularly in high-risk patients. The reopenable clip-over-the-line method (ROLM) is a novel closure technique, but its durability and preventive effects remain unclear. We evaluated the impact of ROLM on delayed bleeding and sustained closure after gastric ESD in high-risk patients. Methods: We retrospectively reviewed gastric ESD cases from April 2021 to December 2024, including only patients with a BEST-J score ≥3, and compared ROLM and non-ROLM groups. In the ROLM group, mucosal closure was confirmed endoscopically on postoperative day 1 (POD1), and clip retention was assessed at 2 months. The primary outcome was delayed bleeding within 28 days. Secondary outcomes included sustained closure on POD1 and clip retention at 2 months. Results: = 0.036). Multivariable models using Firth logistic regression consistently showed a reduced odds ratio (≈ 0.10), although not statistically significant. All ROLM lesions achieved sustained closure on POD1 (100%). At 2 months, 80.9% retained clips. Conclusion: In high-risk gastric ESD patients, ROLM was associated with no delayed bleeding and achieved complete POD1 closure with frequent 2-month clip retention, suggesting a potential for a promising prophylactic strategy.