Post-gastric endoscopic submucosal dissection suturing by the reopenable clip over line method using the clip with line pulley securing technique

Bleeding post-endoscopic submucosal dissection (ESD) is a significant challenge. Various techniques have been developed to reduce the risk of post-ESD bleeding, one of which is the reopenable clip over line method (ROLM) reported by Nomura and colleagues, which is designed specifically to prevent hemorrhage following ESD procedures [1]. Although a final thread stopper is not always necessary in ROLM, securing the thread may enhance the stability of the suture. The locking-clip technique described by this groups achieves both thread closure and cutting simultaneously [2], but it requires a certain level of familiarity to ensure a successful outcome.