Background and Aims
It has been reported that the prophylactic closure of mucosal defects after duodenal
endoscopic resection (ER) can reduce delayed adverse events; however, under certain
circumstances, this can be technically challenging. Therefore, the aim of this study
was to determine the predictors of difficulty during the complete closure of mucosal
defects after duodenal ER.
Methods
This was a retrospective study of duodenal lesions that underwent ER between July
2010 and May 2020. We reviewed the endoscopic images and analyzed the relationships
between the degree of closure or closure time and clinical features of the lesions
using univariate and multivariate analyses.
Results
We analyzed 698 lesions. The multivariate analysis revealed that lesion location in
the medial or anterior wall (odds ratio, 2.8; 95% confidence interval, 1.36-5.85;
P < .01) and a large lesion size (odds ratio, 1.4; 95% confidence interval, 1.07-1.89;
P = .03) were independent predictors of an increased risk of incomplete closure. Moreover,
a large lesion size (β coefficient, .304; P < .01), an occupied circumference over 50% (β coefficient, .178; P < .01), intraoperative perforation (β coefficient, .175; P < .01), treatment period (β coefficient, .143; P < .01), and treatment with endoscopic submucosal dissection (β coefficient, .125;
P < .01) were independently and positively correlated with a prolonged closure time
in the multiple regression analysis.
Conclusions
This study revealed that lesion location in the medial or anterior wall and lesion
size affected the incomplete closure of mucosal defects after duodenal ER, and lesion
size, occupied circumference, intraoperative perforation, treatment period, and treatment
method affected closure time.
Abbreviations:
ENBD (endoscopic nasobiliary drainage), ENPD (endoscopic nasopancreatic drainage), ER (endoscopic resection), ESD (endoscopic submucosal dissection), IQR (interquartile range), P1 (phase 1 (July 2010 to June 2016)), P2 (phase 2 (July 2016 to March 2018)), P3 (phase 3 (April 2018 to April 2019)), P4 (phase 4 (May 2019 to May 2020)), UEMR (underwater EMR)To read this article in full you will need to make a payment
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References
- Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia.Gastrointest Endosc. 2018; 88: 676-682
- Current status of endoscopic resection for superficial nonampullary duodenal epithelial tumors.Digestion. 2018; 97: 45-51
- Short- and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors.World J Gastroenterol. 2019; 25: 707-718
- Endoscopic submucosal dissection for superficial duodenal neoplasms.Dig Endosc. 2009; 21: 270-274
- Borderline cases between benignancy and malignancy of the duodenum diagnosed successfully by endoscopic submucosal dissection.Scand J Gastroenterol. 2009; 44: 1377-1383
- Endoscopic submucosal dissection for sessile, nonampullary duodenal adenomas.Endoscopy. 2013; 45: 133-135
- Endoscopic submucosal dissection for duodenal tumors: a single-center experience.Endoscopy. 2013; 45: 136-137
- Clinical outcome of endoscopic resection for nonampullary duodenal tumors.Endoscopy. 2015; 47: 129-135
- Predictors of technical difficulty with duodenal ESD.Endosc Int Open. 2019; 7: E1755-E1760
- Usefulness of endoscopic treatment for duodenal adenoma.Dig Endosc. 2010; 22: 360-365
- Endoscopic submucosal dissection and endoscopic mucosal resection for non-ampullary superficial duodenal tumor.Digestion. 2017; 95: 36-42
- Clinical impact of closure of the mucosal defect after duodenal endoscopic submucosal dissection.Gastrointest Endosc. 2019; 89: 87-93
- Efficacy of endoscopic preventive procedures to reduce delayed adverse events after endoscopic resection of superficial nonampullary duodenal epithelial tumors: a meta-analysis of observational comparative trials.Gastrointest Endosc. 2021; 93: 367-374
- "Underwater" EMR of sporadic laterally spreading nonampullary duodenal adenomas (with video).Gastrointest Endosc. 2013; 78: 496-502
- Water pressure method for duodenal endoscopic submucosal dissection.Endoscopy. 2017; 49: E227-E228
- Water pressure method for duodenal endoscopic submucosal dissection (with video).Gastrointest Endosc. 2021; 93: 942-949
- New endoscopic suturing method: string clip suturing method.Gastrointest Endosc. 2016; 84: 1064-1065
- Management of perforation related to endoscopic submucosal dissection for superficial duodenal epithelial tumors.Gastrointest Endosc. 2020; 91: 1129-1137
- Laparoscopic-endoscopic cooperative surgery for duodenal tumors: a unique procedure that helps ensure the safety of endoscopic submucosal dissection.Endoscopy. 2015; 47: 349-351
- Feasibility of laparoscopic endoscopic cooperative surgery for non-ampullary superficial duodenal neoplasms: single-arm confirmatory trial.Dig Endosc. 2021; 33: 373-380
- Efficacy of an over-the-scope clip for preventing adverse events after duodenal endoscopic submucosal dissection: a prospective interventional study.Endoscopy. 2018; 50: 487-496
- Endoscopic suturing promotes healing of mucosal defects after gastric endoscopic submucosal dissection: endoscopic and histologic analyses in in vivo porcine models (with video).Gastrointest Endosc. 2020; 91: 1172-1182
Article info
Publication history
Published online: April 27, 2021
Accepted:
April 18,
2021
Received:
November 17,
2020
Footnotes
DISCLOSURE: Dr Yahagi; Paid speaker for Olympus, EA Pharma, Takeda Pharmaceuticals, Otsuka Pharmaceuticals, Astra Zeneca, and Daiichi-Sankyo; Advisor to and ownership interest in Olympus; Advisor to Boston Scientific; Consultant to and ownership interest in Top Corporation; Research grant from Kaigen Pharmaceutical and Sanwa Kagaku Kenkyusho. All other authors disclosed no financial relationships.
DIVERSITY, EQUITY, AND INCLUSION: The author list of this paper includes contributors from the location where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
If you would like to chat with an author of this article, you may contact Dr Kato at [email protected]
See CME section; p. 849.
Identification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
