Efficacy of an over-the-scope clip for preventing adverse events after duodenal endoscopic submucosal dissection: a prospective interventional study

Abstract

Background Duodenal endoscopic submucosal dissection (ESD) remains technically challenging, with a high risk of severe adverse events. Because exposure of the duodenal post-ESD mucosal defect to pancreatic juice and bile acid reportedly induces delayed perforation and bleeding, we examined whether defect closure using an over-the-scope clip (OTSC) system was useful for preventing postoperative adverse events. Methods From April 2016 to February 2017, a total of 50 consecutive patients with superficial non-ampullary duodenal epithelial tumors (SNADETs) larger than 10 mm, with no more than semi-circumferential spread, were prospectively enrolled in this study. All of the lesions were treated by experienced ESD operators and the post-ESD mucosal defect was closed using OTSCs. Results All of the SNADETs were completely removed by ESD, with an R0 resection rate of 88.0 %. The mean procedure and closure times were 67.3 ± 58.8 minutes and 9.8 ± 7.2 minutes, respectively. Although complete defect closure was achieved in 94.0 % of the patients (47/50), two patients required surgical conversion. Delayed perforation occurred in only one patient (2.1 %), who did not have successful closure of the defect, as misplacement of the OTSC exposed the muscle layer. Meanwhile, delayed bleeding occurred in three patients (6.3 %); however, the bleeding was easily controlled using endoscopic coagulation. The mean duration of postoperative hospitalization was 5.5 ± 7.2 days. Conclusions Prophylactic defect closure using OTSCs may be effective in reducing severe adverse events after duodenal ESD.

Efficacy and safety of endoscopic submucosal dissection using a scissors‐type knife with prophylactic over‐the‐scope clip closure for superficial non‐ampullary duodenal epithelial tumors

“…19 Between January 2017 and July 2019, OTSC closure was performed with Twin Grasper (TG; Ovesco Endoscopy), as previously reported. 23,24 For a large mucosal defect, multiple OTSCs and conventional clips were used to achieve a complete closure (Fig. 1, Video S2).…”

“…19 Moreover, the over-the-scope clip (OTSC) system reportedly creates a full-thickness closure of iatrogenic gastrointestinal perforations [20][21][22] and the prophylactic closure of mucosal defects after duodenal ESD for SNADETs. 23,24 Thus, this study aims to investigate whether ESD using Clutch Cutter with prophylactic OTSC closure is safe and feasible for the low-invasive treatment of SNADETs.…”

Rare case of severe acute pancreatitis following over‐the‐scope clip‐assisted duodenal endoscopic mucosal resection using a cap‐fitted endoscope in a patient with pancreas divisum

“…b). We and others previously demonstrated the effectiveness of over‐the‐scope clip (OTSC) placement to prevent delayed perforation of the mucosal defect after duodenal endoscopic resection . In the present case, we carefully adjusted the position of the 9‐mm OTSC for prevention of delayed perforation so that it would not come in direct contact with the minor papilla (Fig.…”

Successful traction‐assisted endoscopic submucosal dissection using dental floss and a clip for a huge superficial nonampullary duodenal epithelial tumor with severe fibrosis (with video)

“…d, Video Clip S1, Supporting information). The mucosal defect was completely closed using an endoloop and two 9‐mm over‐the‐scope clips (Ovesco Endoscopy GmbH, Tübingen, Germany) to prevent delayed perforation . The patient did not develop any adverse events and was discharged on day 3 after ESD.…”