Predictors of technical difficulty for complete closure of mucosal defects after duodenal endoscopic resection

Mizutani, Mari; Kato, Motohiko; Sasaki, Motoki; Masunaga, Teppei; Kubosawa, Yoko; Hayashi, Yukie; Kiguchi, Yoshiyuki; Takatori, Yusaku; Murata, Makoto; Matsuura, Noriko; Nakayama, Atsushi; Fukuhara, Seiichiro; Takabayashi, Kaoru; Maehata, Tadateru; Kanai, Takanori; Yahagi, Naohisa

doi:10.1016/j.gie.2021.04.017

Cited by 9 publications

(11 citation statements)

References 19 publications

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“…Complete closure of large duodenal defects is technically challenging because of limited working space and difficult scope maneuvering. Lesions on the medial or anterior wall and larger lesion sizes are associated with incomplete closure 45 . The duodenal bulb is also unfavorable for complete closure because of its absence of stretching mucosa and abundant folds 38 …”

Section: Duodenal Post‐esd Closurementioning

confidence: 99%

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Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade

Kobara

Tada

Fujihara

et al. 2022

Digestive Endoscopy

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Endoscopic submucosal dissection (ESD), which enables curative en bloc resection of early gastrointestinal neoplasms, has been an attractive minimally invasive surgery during the past two decades. Large post‐ESD defects must be carefully managed to prevent adverse events (AEs). The major AEs comprise delayed bleeding (DB) and delayed perforation (DP), and overall AEs comprise DB plus DP. This review aimed to clarify the clinical efficacy and technical outcomes of endoscopic prophylactic closure for post‐ESD defects. We identified studies involving ≥10 patients up to March 2022 in which endoscopic closure was applied for gastric, duodenal, and colorectal post‐ESD defects. In the stomach, total rates of overall AEs and DB were significantly lower in the closure than non‐closure group. In the duodenum, total rates of overall AEs, DB, and DP were significantly lower in the closure group. In the colorectum, total rates of overall AEs and DB were significantly lower in the closure group. Closure techniques, categorized into three groups (clip‐based techniques, mechanical clipping, and surgical stitch‐based techniques), were illustrated. Endoscopic closure demonstrated a certain ability to reduce DB after gastric, duodenal, and colorectal ESD as well as DP after duodenal ESD. Considering closure‐associated costs, the indications and limitations of closure techniques should be further investigated.

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Section: Duodenal Post‐esd Closurementioning

confidence: 99%

“…Lesions on the medial or anterior wall and larger lesion sizes are associated with incomplete closure. 45 The duodenal bulb is also unfavorable for complete closure because of its absence of stretching mucosa and abundant folds. 38 The complete closure rate is 67% for clip-based techniques 37 and 92% to 94% for OTSC.…”

Section: Duodenal Closure Techniquesmentioning

confidence: 99%

Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade

Kobara

Tada

Fujihara

et al. 2022

Digestive Endoscopy

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“…Postoperative perforation and bleeding are serious complications of duodenal endoscopic submucosal dissection (ESD) 1 . We previously described the reopenable clip over-the-line method (ROLM), a technique used to close mucosal defects after ESD using a line and a reopenable clip 2 3 4 .…”

Section: Figmentioning

confidence: 99%

Reopenable clip over-the-line method with muscle layer grasping clips for large duodenal post-endoscopic submucosal dissection defects

et al. 2022

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Fig. 1 Schema of the reopenable clip over-the-line method with muscle layer grasping clips (ROLM-M). a A large mucosal defect (red arrow) after multiple ROLM closure. b ROLM placement of the reopenable clip on the central muscle layer of the mucosal defect. c ROLM placement of the reopenable clip on the contralateral mucosal defect and the nearby muscle layer. d Gradual closure of the mucosal defect by pulling the line, with no dead space between the mucosa and muscle layers. Nomura Tatsuma et al. Reopenable clip over-the-line … Endoscopy | © 2022. The Author(s).

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“…Recently, Mizutani et al analyzed the risk factors for incomplete closure after duodenal ER and they found medial/anterior wall of lesion location and larger lesion size (especially >40mm) were independent predictors for incomplete closure. 74 Another means to prevent delayed AE is to suture the wound from outside the duodenum by laparoscopy. 75 Recently a multi-center retrospective case series including a total of 206 cases underwent D-LECS revealed favorable outcomes with 95% of R0 resection rate and 4.4% of Clavien-Dindo classification of three or more (perforation 1.5%, stenosis 1.9%, and bleeding 1%).…”

Section: Management and Prevention Of Delayed Aementioning

confidence: 99%

“…Recently, Mizutani et al. analyzed the risk factors for incomplete closure after duodenal ER and they found medial/anterior wall of lesion location and larger lesion size (especially >40mm) were independent predictors for incomplete closure 74 …”

Section: Management and Prevention Of Delayed Aementioning

confidence: 99%

Endoscopic resection of superficial non‐ampullary duodenal epithelial tumor

2021

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Although superficial non‐ampullary duodenal epithelial tumor (SNADET) was previously considered a rare disease, in recent years, the opportunities to detect and treat SNADET are increasing. Considering the high morbidity of pancreatoduodenectomy, endoscopic resection can be a treatment option that preserves the organs and contributes maintain patients’ quality of life. Endoscopic mucosal resection (EMR) is a standard treatment for relatively small lesions in gastrointestinal tracts, however, it is difficult because submucosal fibrosis frequently occurs due to the previous biopsy. Recently, some modified EMR techniques including underwater EMR (UEMR) and cold polypectomy (CP) have been proposed. In UEMR, the duodenal lumen is filled with water or saline and resected the targe lesion with a snare without injection into the submucosa. It would be a treatment option that could reduce candidates for ESD especially SNADET less than 20 mm. CP was reported as a safe and convenient means for SNADET. It would also be one of the standard treatments for diminutive lesions, though there remain some concerns on its resectability. ESD for SNADET is technically challenging, especially with an extremely high risk of adverse event (AE) with a reported bleeding rate of more than 20% and perforation rate up to about 40%. However, modified treatment techniques including the water pressure method and pocket creation method have been reported to potentially contribute to improving outcomes of ESD. Moreover, accumulated evidence shows closing the mucosal defect significantly reduces delayed adverse events after duodenal endoscopic treatments. Further studies are warranted to elucidate curative criteria, long‐term outcomes, and appropriate surveillance strategy.

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Predictors of technical difficulty for complete closure of mucosal defects after duodenal endoscopic resection

Cited by 9 publications

References 19 publications

Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade

Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade

Reopenable clip over-the-line method with muscle layer grasping clips for large duodenal post-endoscopic submucosal dissection defects

Endoscopic resection of superficial non‐ampullary duodenal epithelial tumor

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