Overtube Use Reduces the Incidence of Aspiration Pneumonia Following Gastric Endoscopic Submucosal Dissection: A Large, Single‐Center Japanese Experience

ABSTRACT Background and Aims Aspiration pneumonia (AP), a major adverse event (AE) associated with gastric endoscopic submucosal dissection (ESD), particularly in older adults, has limited effective preventive strategies. Additionally, the efficacy of using overtube (OT) during gastric ESD for reducing AP incidence is not completely understood. Methods In a single‐center, we retrospectively observed 1617 patients undergoing gastric ESD between January 2010 and May 2023. The patients were stratified based on OT use (OT group, n = 488; non‐OT group, n = 1129) and AP development (AP group, n = 23; non‐AP group, n = 1594). The primary endpoint was AP incidence, whereas identifying protective factors against AP and evaluating the safety of OT use were the secondary endpoints. Results AP incidence was significantly lower in the OT group than in the non‐OT group (0.40% vs. 1.86%, p = 0.022) despite the OT group having a higher median age. Multivariate logistic regression analysis identified nonelderly status (age <75 years) (odds ratio [OR] 0.22, p < 0.001) and OT use (OR 0.18; p = 0.023) as protective factors against AP following gastric ESD. No significant increase in OT‐related AEs was observed, indicating its procedural safety. Conclusion OT use during gastric ESD significantly reduces AP incidence without increasing procedural risks. This strategy may be particularly valuable as the older adult population undergoing ESD increases. Trial Registration : N/A.