S2195 To Close or Not to Close: A Systematic Review and Meta-Analysis of Outcomes Following Mucosal Defect Closure After Gastric ESD

Introduction: Endoscopic submucosal dissection (ESD) is a widely accepted therapeutic modality for the management of precancerous and early gastric cancer. However, it results in artificial ulcers, which increase the risk of delayed bleeding and perforation. While prophylactic closure of post-ESD defects has demonstrated benefit in colonic lesions, the clinical value of defect closure in the gastric setting remains uncertain. We conducted a systematic review and meta-analysis to evaluate the impact of defect closure versus non-closure following gastric ESD on clinical outcomes. Methods: A systematically searched databases to identify studies comparing closure versus non-closure of mucosal defects following gastric ESD. Primary outcomes included delayed bleeding and delayed perforation. Pooled estimates were calculated using a random-effects model. Effect measures were reported as risk ratios (RR) and standardized mean differences (SMD), with 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I² statistic. Results: A total of 7 studies comprising 1,951 patients (N = 888 Closure, N = 1063 Non-Closure) were included. The closure group had 77.3% men, while the non-closure group had 79.4%. Mean age was 73.3 ± 6.5 years in the closure and 71.8 ± 6.2 in the non-closure group. Analysis revealed a significantly lower delayed bleeding rate in the closure group compared to the non-closure group (3.0% vs 12.4%; RR 0.29, 95% CI: 0.11–0.73, P = 0.009; I² = 68.9). The rate of delayed perforation was 0% in both groups. There were no significant differences between groups in specimen size (SMD -0.17, 95% CI: -0.52–0.77; P = 0.34) or procedure time (SMD 0.34, 95% CI: -0.52–1.19; P = 0.45). In the closure group, complete closure rate was 90% (75.7–96.3), sustained closure rate was 69.9% (45.3–86.6), and mean closure time was 23.8 minutes (17.8–29.8). Conclusion: Closure of the mucosal defect following gastric ESD significantly reduces the risk of delayed bleeding. This benefit appears consistent across closure techniques and diverse patient populations, supporting its consideration as a routine adjunct, particularly in patients at elevated bleeding risk. Further studies are warranted to determine the optimal closure methods and to establish standardized protocols.