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In this study, we propose a method for downscaling ecological footprint (EF) and biocapacity (BC) to a 1-km square resolution for a spatially flexible analysis of environmental burden balance. To conduct EF downscaling (by land type and consumption category) for all terrestrial areas of Japan, the grid population was multiplied by the scaled EF per capita based on the consumption expenditures and income statistics available at the municipal level. The BC of each land type was estimated following the land-use map. Subsequently, a balance analysis between EF and BC showed the spatial distribution of EF, BC, and the environmental load excess ratio (EF/BC). The values of the environmental load excess ratio significantly varied between grids, and the spatial distributions differed depending on the land type. An example of multiscale balance analysis at municipal and prefectural scales by the developed dataset showed the different distributions of the environmental load excess ratio due to the scale of spatial boundaries and demonstrated its contribution to designing interregional cooperative policies from a multilayered perspective. The established high-resolution dataset can be utilized practically for flexibly analyzing the multilayered spatial boundaries to fill the scale mismatch between natural resources and administrative boundaries. The downscaling method proposed in this study can be applied beyond Japan if similar sets of statistics and land-use information are available, which will significantly improve the spatial resolution of the analysis.

Background: The most suitable procedure for resecting small-sized gastric neoplasms remains unclear. Endoscopic mucosal resection leads to non-curative resection owing to slippage of the snare, and technically difficult endoscopic submucosal dissection (ESD) is instrumentally uneconomical. A novel, cost-effective, multifunctional snare called SOUTEN is available as a hybrid ESD (h-ESD) device developed for facilitating ESD. This study aimed to assess the acceptability of h-ESD using the SOUTEN for resecting small-sized gastric neoplasms. Methods: This was a prospective observational study conducted at our single institution between March 2019 and March 2021. Fifty-seven consecutive patients who underwent h-ESD using SOUTEN for small-sized gastric neoplasms ≤ 15 mm involving adenoma and tubular-type mucosal carcinoma without ulceration were enrolled. The primary outcome was en bloc resection rate of h-ESD. Secondary outcomes were the rates of curative resection, conversion to ESD, procedure time, rates of intra-and post-operative complications, and presence of additional knives excluding hemostatic forceps. Results: The en bloc resection rate of h-ESD was 91.2% (52/57). The curative resection rate was 94.7% (54/57) including conversion to ESD cases. The mean procedure time was 21.2 (± 16.5) minutes. One case of delayed bleeding occurred. Additional knives were applied in two cases. Conclusion: The cost-efficient h-ESD using SOUTEN can be an acceptable procedure for resecting small-sized gastric neoplasms.

Duodenal endoscopic submucosal dissection (ESD) is associated with high incidences of intraoperative complications and delayed adverse events (AEs). Delayed AEs can be reduced by closing the post-ESD defects. We developed a new method of closure after duodenal ESD, combining endoscopic ligation with O-ring closure (E-LOC) with an over-the-scope clip (OTSC) (Band OTSC; B-OTSC). Here, we conducted a single-center, retrospective, observational study to investigate the efficacy and safety of the B-OTSC method for preventing delayed AEs in patients undergoing duodenal ESD. The study included nine patients with superficial nonpapillary duodenal epithelial tumors who underwent ESD and were closed with B-OTSC from February 2021 to February 2023. There were no delayed AEs (0%), the mean (± standard deviation) closure time was 53 ± 21.6 min, the complete closure rate was 100%, and the mean hospital stay was 7.8 ± 1.8 days. The sustained closure rates at postoperative days 3 and 7 were 88.9% and 88.9%, respectively. The historical analysis indicated a significant difference in cost between B-OTSC and conventional OTSC (p < 0.01). In conclusion, B-OTSC was a safe, secure, and cost-effective method of closure after duodenal ESD, even in patients with post-ESD defects of more than half the circumference.

Sharing successful practices with other stakeholders is important for achieving SDGs. In this study, with a deep-learning natural language processing model, bidirectional encoder representations from transformers (BERT), the authors aimed to build (1) a classifier that enables semantic mapping of practices and issues in the SDGs context, (2) a visualizing method of SDGs nexus based on co-occurrence of goals (3) a matchmaking process between local issues and initiatives that may embody solutions. A data frame was built using documents published by official organizations and multi-labels corresponding to SDGs. A pretrained Japanese BERT model was fine-tuned on a multi-label text classification task, while nested cross-validation was conducted to optimize the hyperparameters and estimate cross-validation accuracy. A system was then developed to visualize the co-occurrence of SDGs and to couple the stakeholders by evaluating embedded vectors of local challenges and solutions. The paper concludes with a discussion of four future perspectives to improve the natural language processing system. This intelligent information system is expected to help stakeholders take action to achieve the sustainable development goals. Supplementary Information The online version contains supplementary material available at 10.1007/s11625-022-01093-3.

SMTP-44D has been reported to have anti-oxidative and anti-inflammatory reactions, including reduced expression of receptor for advanced glycation end products (RAGE) in experimental diabetic neuropathy. Although activation of RAGE with its ligands, and advanced glycation end products (AGEs), play a crucial role in atherosclerotic cardiovascular disease, a leading cause of death in diabetic patients, it remains unclear whether SMTP-44D could inhibit experimental atherosclerosis by suppressing the AGEs–RAGE axis. In this study, we investigated the effects of SMTP-44D on atherosclerotic plaque formation and expression of AGEs in apolipoprotein-E null (Apoe−/−) mice. We further studied here whether and how SMTP-44D inhibited foam cell formation of macrophages isolated from Apoe−/− mice ex vivo. Although administration of SMTP-44D to Apoe−/− mice did not affect clinical or biochemical parameters, it significantly decreased the surface area of atherosclerotic lesions and reduced the atheromatous plaque size, macrophage infiltration, and AGEs accumulation in the aortic roots. SMTP-44D bound to immobilized RAGE and subsequently attenuated the interaction of AGEs with RAGE in vitro. Furthermore, foam cell formation evaluated by Dil-oxidized low-density lipoprotein (ox-LDL) uptake, and gene expression of RAGE,cyclin-dependent kinase 5 (Cdk5) and CD36 in macrophages isolated from SMTP-44D-treated Apoe−/− mice were significantly decreased compared with those from saline-treated mice. Gene expression levels of RAGE and Cdk5 were highly correlated with each other, the latter of which was also positively associated with that of CD36. The present study suggests that SMTP-44D may inhibit atherosclerotic plaque formation in Apoe−/− mice partly by blocking the AGEs-RAGE-induced ox-LDL uptake into macrophages via the suppression of Cdk5-CD36 pathway.

Esophagogastroduodenoscopy (EGD) is an aerosol-generating procedure. A major challenge in the COVID-19 era is how to prevent the spread of aerosols and droplets in endoscopic units. We evaluated the effectiveness of an extraoral suction device in preventing indoor aerosol diffusion and droplet exposure for examiners. The study involved 61 patients who underwent EGD at our institution from 1 February to 31 March 2022. To determine whether aerosol spread increases before or after EGD examination with an extraoral suction device located in front of the patient’s mouth, aerosols of 0.3, 0.5, 1, 3, 5, and 10 μm were measured with a handheld particle counter. The degree of contamination of the plastic gowns on the examiners was assessed using the rapid adenosine triphosphate test. The extraoral suction device significantly reduced the diffusion of large particles (3, 5, and 10 μm) after finishing the EGD examination. However, the diffusion of small particles (0.3 and 0.5 μm) was significantly increased. This extraoral suction device was effective in reducing large particle diffusion during EGD examination but was limited for minimizing small particle diffusion or droplet exposure to the examiner.

Envisioning positive scenarios that recognize the multiple values of nature is fundamental for designing transformative changes in local socio-ecological systems. This study developed a protocol with three specifications for operationalizing the Nature Futures Framework (NFF) in a landscape scenario analysis using a multi-objective optimization framework composed of: (1) exploring nature-positive futures, (2) seeking alternative pathways for targets satisfying visions of plural values, and (3) screening key direct drivers to achieve the targets. This research conducted a case study of a rural landscape in northeastern Japan. First, 110 strategies of landscape management options were simulated from 2015 to 2100 using a forest landscape model, LANDIS-II. The simulation developed a data frame of four integrated indicators of the NFF values for each year and strategy. Second, nature-positive strategies were screened using the common values. Pareto optimal strategies were then identified to obtain equally good solutions. Finally, the key response options to achieve good nature-positive futures were identified using decision tree analysis. Our protocol identified (1) multiple, but few nature-positive and Pareto optimal strategies that satisfied NFF visions, (2) nature-positive, but not Pareto optimal strategies, and (3) non-nature-positive strategies. In most Pareto optimal strategies, the maximized value perspectives changed over time. Our protocol also identified key response options to achieve three different NFF value perspectives in the case study area: (1) clear or selective cutting in forestry and (2) solar PV installation on abandoned pastureland in agriculture and energy sectors. We discussed the implication for local landscape management, localizing NFF narratives to develop future scenarios and modeling practice of NFF. The protocol does not depend on a specific model and indicator. Thus, our scalable protocol can be applied to scenarios and model practices in any region to support envisioning plausible, feasible, and positive futures, and designing future stakeholder collaboration.

Despite available remote sensing data, technical challenges in developing countries have hindered local urban authorities from updating periodic land cover maps. Therefore, this study proposed a practical approach for regions with insufficient ground truth data. The study implemented a machine learning algorithm using single date medium spatial resolution data to build a classifier for separating Urban and Non-Urban zones. Then, the classifier was employed on multiple dates in 1999, 2005, and 2011 to corroborate its robustness. Results showed the stochastic gradient boosting (SGB) algorithm succeeded in building a robust classifier using the digital number value of LANDSAT-5TM 2005 with an overall accuracy of 0.76 and an area under curve receiver operator characteristic (AUC-ROC) value of 0.83. Moreover, the classifier predicted that urban areas in Yogyakarta, Indonesia, reached 24,099 (hectares) ha; 26,598 ha; and 22,650 ha in 1999, 2005, and 2011, respectively. The classifier's performance in predicting multiple datasets combined with histogram matching of medium spatial resolution data showed satisfactory results comparable to reference data from Statistics Indonesia, indicating sufficient accuracy for areal-integrated multi-temporal urbanization monitoring.

Dihydropyrimidine dehydrogenase (DPYD) genotype is closely associated with fluoropyrimidine (FP)-induced toxicities in Caucasian population and European Medicines Agency now recommends DPYD genotype-based FP dosing strategy.The current study aimed to investigate their impact on FP-related toxicities in an Asian population using genome-wide association study (GWAS) data set from 1364 patients with colon cancer.Among 82 variants registered in the Clinical Pharmacogenetics Implementation Consortium, 74 DPYD variants were directly genotyped in GWAS cohort; however, only 7 nonsynonymous DPYD variants (CPIC variants) were identified and none of the four recurrent DPYD variants (DPYD*2A, c.2846AT, c.1679TG, c.1236GA) were included. Seven CPIC variants were investigated for their association with the incidence of FP-related toxicities; however, none of these variants revealed a significant correlation with FP-related toxicities.These data suggested that the DPYD genotype registered in CPIC plays a minor role in FP-related toxicities in an Asian population.

Context Forest landscape management practices that conserve species composition and maximize carbon sequestration despite changes in climate and disturbance regimes are required to achieve social and environmental targets. Although post-windthrow management, such as salvage logging, can reduce carbon dioxide (CO2) emissions within ecosystems by removing downed logs, it can result in major changes in tree species composition. Additionally, the net effects of salvage logging on CO2 emissions may become negative based on a cradle-to-grave analysis (i.e., all aspects of wood processing including manufacturing and the disposal of wood products made from windthrow-damaged trees). Objectives Our objective was to assess the effects of climate change, changes in windthrow regimes, and post-windthrow management on tree species composition, as well as on the carbon balance in the forest sector by combining forest landscape simulations and life cycle assessments at the forested landscape in northern Japan. Methods We simulated forest dynamics in 36 scenarios based on features of the climate, windthrow regime, and post-windthrow management using the LANDIS-II forest landscape model. We also estimated CO2 emissions related to post-windthrow management using a life cycle assessment approach. Results Increases in the windthrow area, which is more vulnerable to climate warming, resulted in the development of temperate broadleaf-dominant forests and a decrease in aboveground biomass. The removal of advanced seedlings and dead woods due to post-windthrow management accelerated changes in the aboveground biomass and species composition due to the increase in windthrow frequency and intensity and temperature. The cumulative net CO2 absorption of the forest sector over 115 years, including the carbon balance within ecosystems and the CO2 emissions related to the management, manufacturing, and disposal of products, greatly decreased due to salvage logging and scarification after logging. Conclusions Our results demonstrate that leaving downed logs and advanced seedlings is recommended to conserve species composition and carbon sink function and maximize net CO2 absorption despite a warming climate and more frequent and intense windthrow regimes.

In order to calculate the A-weighted single event sound exposure level () of aircraft noise, the following method is described in the manual for aircraft noise measurement in Japan. Firstly a time-section, which is the range between two points where the noise level is 10 dB lower than the maximum noise level (), should be identified, and secondly the energy within the section is integrated. This method can easily be applied to the single event noises. When multiple aircraft noises are overlapped simultaneously, there are cases where cannot be calculated adequately by this method. In such cases, it is required to record the number of aircraft noises in the field measurements. However, even in the case of manned measurement, it is not easy to separate sound sources just by listening to the sound. A pilot study of the psychoacoustic experiment was conducted using the stimuli where multiple aircraft noises were overlapped in order to find what condition is needed so that multiple aircraft noises were separately perceived. It was suggested that a considerable time interval was needed so that people felt the separation between aircraft noises only with auditory information.

Background The recently developed endoscopic full-thickness resection technique requires reliable closure. The main closure methods are the purse-string suture (PSS) technique and over-the-scope clip (OTSC) technique; however, basic data on the closure strength of each technique are lacking. This study was performed to compare the closure strengths of these two methods in an ex vivo porcine model. Methods In the traction test, a virtual 5-cm full-thickness closure line was closed by the following six methods three times each: conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture. The primary endpoint was the tension at the starting point of dehiscence, measured in Newtons (N) by an automatic traction machine. In the leak test, a 15-mm gastric full-thickness defect was closed by PSS or OTSC six times each, and the closed stomach was then pressurized in a water container. The primary endpoint was the leak pressure when air bubbles appeared. The secondary endpoints were the procedure time and presence of complete inverted closure. Results The mean tension was 2.16, 3.68, 5.15, 18.30, 19.30, and 62.40 N for conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture, respectively. Complete inverted closure was observed for seromuscular PSS, seromuscular OTSC, and surgical suture. The mean leak pressure was 13.7 and 24.8 mmHg in the PSS and OTSC group, respectively (P Conclusion The OTSC, which allows complete inverted closure, showed greater closure strength than PSS. Considering the size limitation suitable for single OTSC, a therapeutic strategy for closing the larger size is further warranted.

Background/aim Hepatocellular carcinoma (HCC) remains one of the biggest medical issues. Pigment epithelial-derived factor (PEDF) is a glycoprotein that belongs to the superfamily of serine protease inhibitors. PEDF interacts with its two receptors, adipose triglyceride lipase (ATGL) and laminin receptor (LR). Materials and methods We conducted immunohistochemical staining for PEDF, LR and ATGL in 151 resected HCCs and their background liver tissues. Results High expression of LR in HCC was associated with high histological grade and portal vein invasion, while high expression of PEDF in HCC was associated with absence of portal vein invasion. High LR expression in background liver was statistically associated with low serum albumin levels and was an independent prognostic factor of worse outcomes. No cases with more than 5% fatty degeneration in the background liver tissue showed high PEDF expression. Conclusion PEDF/LR/ATGL could be potential biomarkers in HCC and various chronic hepatic disorders.

Introduction Pigment epithelium-derived factor (PEDF) may play a role in cardiometabolic disorders. The aim of this study was to investigate which biochemical and clinical parameters are independently associated with serum PEDF levels in patients with type 2 diabetes mellitus (T2DM). Methods We performed a cross-sectional analysis of 124 patients with T2DM who underwent continuous glucose monitoring (CGM) and blood chemistry analysis, including the diacron-reactive oxygen metabolites (d-ROMs) test and serum PEDF measurement (study 1). Then we investigated whether the changes in the studied biochemical and clinical parameters after 24 weeks of treatment (Δparameters) with anti-hyperglycemic agents, including sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and/or insulin and anti-hypertensive drugs and statins, were independently correlated with change in PEDF (ΔPEDF) in 52 of the patients with T2DM for whom there was sufficient serum samples to perform the post-treatment analysis (study 2). Serum levels of PEDF were measured with an enzyme-linked immunosorbent assay. CGM metrics were calculated on days 2 and 3. Oxidative stress was evaluated using the d-ROMs test. Results Body mass index (BMI), triglycerides, fasting C-peptide, mean amplitude of glycemic excursions (MAGE), urinary albumin-to-creatinine ratio (UACR), and d-ROMs were positively associated with serum PEDF level, and high-density lipoprotein cholesterol (HDL-C) and estimated glomerular filtration rate (eGFR) were inversely associated with serum PEDF level. Because these parameters were correlated with each other, multivariate stepwise analysis was performed: eGFR, HDL-C, BMI, MAGE, and UACR remained significant (R2 = 0.452). Furthermore, ΔMAGE and Δd-ROMs were positively correlated with ΔPEDF in study 2. Conclusions The results of this study suggest that MAGE may be independently correlated with elevations in serum PEDF level in patients with T2DM.

The management of postoperative bleeding, after gastric endoscopic submucosal dissection (ESD), has become particularly important because of the recent increase in antithrombotic use. Endoscopic shielding with polyglycolic acid (PGA) sheets has been shown to be effective. However, shrinkage and early displacement of the sheet remain challenges. This study aimed to determine the efficacy and safety of our developed method, named wafer paper and ring-mounted PGA sheet (WaRP).Twenty-four patients with antithrombotic uptake who underwent the WaRP method following gastric ESD were retrospectively examined. This involved the delivery of a PGA sheet wrapped in wafer paper with ring-thread, and its fixation on the gastric floor using hemoclips. The primary outcome was the technical success rate of the WaRP, and several secondary outcomes were evaluated.The technical success rate of WaRP was 100%. The procedure lasted a mean of 10.5 min (SD 6.7 min). The prevalence of complete retention at follow-up endoscopy was 83.3% (20/24). There were no WaRP-associated complications, but post-ESD hemorrhage occurred in two patients undergoing hemodialysis (8.3%).The WaRP method is a simple and reliable means of PGA sheet delivery and placement that reduces the incidence of post-ESD hemorrhage.

Recently, natural capital has gained the attention of researchers and policymakers to promote sustainability. Previous studies have investigated the value of ecosystem services with respect to specific areas or species. Other studies have investigated the value of various types of ecosystem services and natural capital by integrating a number of findings using meta-analyses at the global level. Although these studies have provided information on either the global value of natural capital or the local value of specific subjects, there is little evidence on the country-specific values of natural capital in Japan, which will provide useful information for national environmental policies. We investigated the perceived values of terrestrial and marine natural capital in Japan using internet surveys and payment card methods. Data on various natural forms of capital were collected in a unified format and comparable manner. We found that some explanatory variables, such as perceived importance and visit frequency, as well as sociodemographic characteristics, are significant drivers of the willingness to pay (WTP), which maintains each aspect of natural capital. In addition, we conducted future predictions of terrestrial and marine natural capital using a scenario developed in a previous study. Our results indicate that Japan should follow a population-dispersed scenario for the sustainable management of natural capital up to 2050.

Background/Aim: Colorectal endoscopic submucosal dissection (ESD) is a difficult technique. Counter-traction may facilitate the procedure but its efficacy in non-experts remains unclear. We determined the safety and efficacy of pocket creation and ring-thread traction (PRM) for non-expert colorectal ESD. Patients and Methods: We retrospectively compared patients who underwent conventional colorectal ESD (C-group, n=50) or PRM (pocket creation, whole-circumferential cutting, ring-thread traction, submucosal dissection; PRM-group, n=48). All procedures were performed by four non-experts, each with ≤40 experiences of colorectal ESD. Results: Procedural time was significantly shorter in the PRM-group compared with the C-group (p=0.007), with less additional device usage (p

Aim Neoadjuvant chemotherapy (NAC) is promising to improve the survival of resectable gastric cancer. However, suitable regimen and treatment duration for NAC have not yet been established. Methods We conducted a randomized phase II trial to compare two and four courses of neoadjuvant S‐1/cisplatin (SC) and S‐1/cisplatin/docetaxel(DCS) using a two‐by‐two factorial design for locally resectable advanced gastric cancer. Patients with M0 and either T4 or T3 in case of junctional cancer or scirrhous‐type cancer received two or four courses of SC or DCS. Then, patients underwent D2 gastrectomy and adjuvant S‐1 chemotherapy for 1 year. The primary endpoint was 3‐year overall survival. The planned sample size was 120 eligible patients. Results Between October 2011 and September 2014, 132 patients were assigned to CS (n = 66; 33 in 2‐courses and 33 in 4‐courses) and DCS (n = 66; 33 in 2‐courses and 33 in 4‐courses). The 3‐year OS was 58.1% in CS and 60.0% in DCS with hazard ratio of 0.80 (95% CI, 0.48‐1.34), while it was 53.1% in the two courses and 65.0% in the four courses with hazard ratio of 0.72 (95% CI, 0.43‐1.22). In the survival analysis by duration in each regimen, the 3‐year OS was 58.1% for both two and four courses in CS, while it was 48.5% for two courses of DCS and 71.9% for four courses of DCS. Conclusions Considering high 3‐year OS, four courses DCS has a value to be tested in a future phase III study to confirm superiority of neoadjuvant chemotherapy for locally advanced gastric cancer., Overall survival curves stratified by regimens, number of courses.

This study develops a projection model of future population distribution on the basis of Japan’s current depopulation trend and applies this model to scenario analyses that assume population compactification and dispersion. The model enables a description of population migration at two levels. First, municipal populations are projected using the cohort-component method, and second, the spatial distribution of populations within municipalities is projected at a 500 m grid resolution with the use of the gravity model. Based on the Japanese depopulation context and the country’s National Spatial Strategy, the compact scenario predicts the formation of medium-scale regional urban areas (population centers located across Japan) and the concentration of people on high-density population areas within municipalities. Meanwhile, the dispersed scenario predicts the formation of more but smaller regional urban areas and the dispersion of the population to low-density areas. The simulated population distribution for 2050 reveals spatial change in population density and age structure, as well as an abundance of areas that were inhabited in 2015 but will be zero population areas by 2050. Overlay analysis of future land use maps and the simulated population distribution maps can contribute toward identifying areas where natural capital such as farmland and forest plantation should be managed but where there will be significant population loss by 2050. Electronic supplementary material The online version of this article (10.1007/s11625-020-00835-5) contains supplementary material, which is available to authorized users.

When developing a sustainable local energy system, it is useful to apply backcasting to help select an appropriate renewable energy mix based on an evaluation by diverse stakeholders of multiple possible implementation impacts. The purpose of this study was to propose a co-creative design support method for local energy systems that includes (1) participatory development of a local future vision, (2) quantitative projection of future energy demand coupled with future vision, (3) multi-objective optimization of a regional renewable energy mix consistent with the future vision, and (4) a co-creative optimization process that encompasses local resident preferences. A case study in Takashima, Shiga Prefecture, Japan, was conducted in collaboration with the Takashima Community Promotion Council to test the proposed method. A participatory workshop was conducted with nine officers and 16 citizens to design a qualitative future vision for 2040. This vision was then quantified and the future energy demand was projected using the Extended Snapshot Tool model. Pareto solutions for an optimal renewable energy mix were visualized using the Renewable Energy Regional Optimization Utility Tool for Environmental Sustainability with a multi-objective evolutionary algorithm. One optimal solution was interactively selected according to the preferences of local residents surveyed using a pairwise comparison questionnaire. The proposed method was demonstrated to successfully derive an optimal renewable energy mix for Takashima using backcasting. In addition, it was shown to be a useful method for the co-creation of local energy systems.

Background We examined the efficacy of a novel endoscopic ligation technique with O-ring closure (E-LOC) to prevent bleeding after gastric endoscopic submucosal dissection (ESD) under antithrombotic therapy. Methods This single-center prospective study involved consecutive patients who were taking antithrombotic agents and underwent gastric ESD. E-LOC was performed by anchoring the nylon loop with hemoclips on both defect edges and/or the exposed muscle layer, and using O-ring band ligation around these deployed clips. The primary outcome was post-ESD bleeding rate. Secondary outcomes were complete closure rate, procedure time, sustained closure rate, and complications. Results 48 patients were finally analyzed. The post-ESD bleeding rate was 0 %, the complete closure rate was 97.9 %, and the mean closure time was 29.9 minutes. The sustained closure rate was 95.8 % at postoperative day 2–3 and 33.3 % at postoperative day 10–11. No complications occurred. Conclusion E-LOC may be an effective option for closing mucosal defects after gastric ESD under antithrombotic therapy. However, the preventive effect on post-ESD bleeding should be further investigated in high risk groups.