# Feasibility of Endoscopic Closure Method Using Low Cost Clips With Thread for Post Gastric Endoscopic Submucosal Dissection: A Pilot Study

## TL;DR

A low-cost endoscopic closure method using clips and thread was tested and found effective for preventing delayed bleeding after gastric ESD.

## Contribution

A novel low-cost endoscopic closure method using conventional clips and thread is introduced and evaluated for feasibility and cost-effectiveness.

## Key findings

- Complete closure was achieved in 90% of lesions with sustained closure on POD1 in 85%.
- The median closure time was 17.5 minutes with a median cost of $131.8.
- No cases of delayed bleeding occurred using the LoCC method.

## Abstract

Endoscopic closure in gastric endoscopic submucosal dissection (ESD) is useful to prevent delayed bleeding. Although several closure methods have been reported, their cost remains a significant issue. In this pilot study, we developed a low‐cost endoscopic closure (LoCC) method and evaluated its feasibility and cost‐effectiveness.

We retrospectively analyzed 20 gastric lesions in 18 patients who underwent ESD between September 2024 and July 2025. Mucosal defect closure was performed using the LoCC method, which involves the application of conventional clips and threads to approximate mucosal edges. The primary outcome was the complete closure rate. The secondary outcomes were closure time, number of clips used and their cost, sustained closure rate on postoperative day (POD) 1, and incidence of delayed bleeding.

Complete closure was achieved in 90.0% (18/20) of the lesions, with sustained closure on POD1 in 85.0% (17/20). The median closure time was 17.5 min (interquartile range [IQR]: 12.3–24.0), using a median of 20 clips (IQR: 15–23), at a median cost of 131.8 United States dollars (IQR: 98.8–151.5). No cases of delayed bleeding occurred.

The LoCC method showed favorable technical feasibility and enabled cost‐efficient closure of post‐ESD ulcers compared with other closure methods. This technique achieved a high closure success rate and sustained closure rate without the need for expensive devices, suggesting that it may serve as a practical and feasible closure method in routine clinical practice.