Background and Aims <p>Endoscopic submucosal dissection (ESD) is an effective treatment for gastric neoplasia, but delayed bleeding remains a potential complication. This study evaluated the impact of defect closure techniques on delayed bleeding following gastric ESD.</p> Methods <p>A retrospective analysis was conducted on 135 patients (51% male; mean age 67 ± 15&#xa0;years) who underwent gastric ESD. Lesion characteristics, resection outcomes, closure methods, and adverse events were analyzed. The association between defect closure and delayed bleeding was assessed using Fischer exact test, univariate regression, and multivariable regression.</p> Results <p>The mean lesion diameter was 48 ± 26&#xa0;mm, with lesions primarily located in the stomach body (51%) and antrum/prepyloric region (38%). En-bloc resection was achieved in 97% of cases, with R0 resection in 91.1% and curative resection in 87.4%. Defect closure was performed in 33.3% of cases. Delayed bleeding occurred in 6.7% of patients (n = 9), including 6 in the non-closure group and 3 in the closure group. No cases of deep muscle injury or delayed perforation were observed. There was no significant difference in delayed bleeding between closure and non-closure groups (6.7% vs. 6.5%, P = 1.000). Multivariable analysis further confirmed no significant association between defect closure and delayed bleeding (OR 0.777, 95% CI 0.152–3.965, P = 0.762).</p> Conclusions <p>Defect closure did not significantly reduce delayed bleeding rates in gastric ESD. Routine closure may not be necessary while selective application in high-risk patients warrants further investigation.</p>