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Closure of large mucosal defects for prevention of strictures after duodenal endoscopic submucosal dissection (with video)

  • Yoko Kubosawa
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Motohiko Kato
    Correspondence
    Corresponding author: Motohiko Kato, MD, PhD, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. Telephone: +81-3-5363-3437, Fax: +81-3-5363-3895,
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Motoki Sasaki
    Affiliations
    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Kentaro Iwata
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Kurato Miyazaki
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Teppei Masunaga
    Affiliations
    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Yukie Hayashi
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Mari Mizutani
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Yoshiyuki Kiguchi
    Affiliations
    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

    Preventive Healthcare Plaza, Kurashiki Central Hospital, Okayama, Japan
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  • Yusaku Takatori
    Affiliations
    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Noriko Matsuura
    Affiliations
    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Atsushi Nakayama
    Affiliations
    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Kaoru Takabayashi
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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  • Takanori Kanai
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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  • Naohisa Yahagi
    Affiliations
    Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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Published:October 06, 2022DOI:https://doi.org/10.1016/j.gie.2022.09.026
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      Abstract

      Background and Aims

      Although lesions occupying a large circumference are associated with the risk of post-ESD strictures, the corresponding data for duodenal lesions are unknown. We aimed to analyze the incidence of post-ESD strictures after wide-field duodenal ESD.

      Methods

      In this retrospective study of duodenal lesions treated with ESD, between July 2010 and August 2021, we included lesions that resulted in mucosal defects occupying more than half of the circumference and excluded lesions located in bulbs and involving Vater’s papilla. We analyzed the incidence rates of stricture and luminal narrowing, in addition to bleeding and perforation as the outcomes in this study. Stricture was defined as the inability of the endoscope to pass through the lumen. A single endoscopist reviewed all endoscopic images and judged the degree of luminal narrowing

      Results

      A total of 80 lesions were included, of which two involved mucosal defects occupying more than 90% of the circumference. The wound was closed, at least partially, in 90% in all lesions, and in 86% of lesions with mucosal defect occupying more than 75% of the circumference. None of the lesions caused delayed perforation and stricture, whereas two lesions caused delayed bleeding. Only six lesions caused luminal narrowing. When examined by the degree of closure, the rate of luminal narrowing increased with complete closure, incomplete closure, and un-closure (4.9%, 9.1%, and 25.0%, respectively).

      Conclusions

      Suturing may prevent post-ESD bleeding and perforation, as well as stricture formation in cases of duodenal tumors, with mucosal defects occupying a large circumference.

      acronyms and abbreviations:

      ESD (Endoscopic submucosal dissection)
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