The Effect Of Clip Closure Of Artificial Ulcer Induced By Gastric Endoscopic Submucosal Dissection

Background:Gastric endoscopic submucosal dissection(ESD)is currently the primary treatment for early gastric cancer(EGC),precancerous lesions and submucosal tumors.Gastric ESD has the advantages of less invasive and quicker recovery,but it causes artificial ulcer during dissection.How to effectively treat the artificial ulcer is always a big concern to endoscopists.Presently,proton pump inhibitor(PPI)is the main treatment for artificial ulcer induced by gastric ESD.There is no report on the effect of clip closure on artificial ulcer healing after gastric ESD.Objective:The objective was to explore the effect of clip closure on the artificial ulcers induced by gastric ESD in patients with gastric lesions.Methods:Patients who underwent ESD for gastric lesions in the 6th affiliated Hospital of Guangzhou Medical University were enrolled from January 2019 to March 2021.Patients were randomly assigned to a clip-closure group and a no-closure group by computer generated random number list.In the clip-closure group,the defect of the resection site was completely sutured with endoscopic clips,while in the no-closure group the defect was left open.The general conditions of the two groups were recorded,such as gender,age,postoperative fasting time,length of hospital stay,total cost of treatment,hypertension,Helicobacter pylori(H.pylori)infection,smoking and drinking habits;The size,site of artificial ulcer after gastric ESD were recorded;Postoperative complications such as fever,abdominal pain,bleeding and perforation were recorded;The ulcer size and healing stage after 4 weeks and 8 weeks were measured and recorded again.The ulcer size reduction rate,ulcer healing rate,ulcer improvement rate,postoperative bleeding rate and perforation rate were compared between the two groups.All data were analyzed by SPSS(version 20.0).Results:A total of 67 patients underwent gastric ESD were enrolled into the study,55patients were successfully follow-up.There were 35 cases in the clip-closure group,20patients in the no-closure group.There was no statistically significant difference among sex,age,postoperative fasting time,length of hospital stay,total cost of treatment,hypertension,H.pylori infection,smoking and drinking habits.The ulcer size after gastric ESD was 518.1±306.5 mm~2in the clip-closure group and 567.3±360.8 mm~2in the no-closure group,the difference was not statistically significant.After 4 weeks,the median size of ulcer area was 0(0,12)mm~2 in clip-closure group and 13.5(0,26.3)mm~2 in no-closure group,the difference was not statistically significant(P=0.05).The ulcer healing rate in the clip-closure group was significantly higher than that in no-closure group(69.6%vs 40%,P=0.04).The ulcer size reduction rate and ulcer improvement rate in the clip-closure group were higher than the no-closure groups(ulcer size reduction rate:100%vs 98%,P=0.07;ulcer improvement rate:80%vs 65%,P=0.22),but the difference was not statistically significant.After 8 weeks,the ulcer healing rate(100%vs 90%,P=0.13)and ulcer improvement rate(100%vs 95%,P=0.36)of clip-closure group were higher than the no-closure groups,there was no statistically significant difference.On univariate analysis,clipping the artificial ulcer(P=0.04)and site(P<0.001)were associated with the healing of artificial ulcer after 4 weeks,and clipping artificial ulcer(P=0.04)was also associated with the healing process after 8 weeks.On multivariate analysis,both clipping the artificial ulcer and site were not predictor of ulcer healing.In the clip-closure group,abdominal pain occurred in 5 patients,delayed bleeding occurred in 1 patient,fever and perforation did not occur.In the no-closure group,delayed bleeding occurred in 1 patient,abdominal pain,fever and perforation did not occur.There was no significant difference in the rate of complications between the two groups(P=0.10).Conclusions:Clipping the artificial ulcer induced by gastric ESD improved the healing process.