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Endoscopic line-attached clipping closure with laparoscopic suturing for duodenal defects involving the medial wall post-endoscopic submucosal dissection
Duodenal endoscopic submucosal dissection (ESD) is difficult to perform owing to a high incidence of complications, including intra/post-ESD perforation and bleeding. A complete closure of the post-ESD mucosal defect can prevent post-ESD perforation, but the success of a complete endoscopic closure depends on the size and location of the defect . Although laparoscopic seromuscular suturing is the most reliable closing method , it cannot be used for duodenal lesions over the medial wall.
A 50-year-old man was endoscopically diagnosed with a duodenal adenoma, which was a flat, elevated, 3-cm lesion located near the ampulla and extended from the medial wall to the anterior wall of the second portion of the duodenum ([Fig. 1]). This lesion was judged as an indication for ESD, but it was difficult to achieve a complete closure with endoscopic clipping. Hence, duodenal ESD was planned, followed by a combined closure method including endoscopic line-attached clipping and laparoscopic suturing.
Endoscopic pancreatic stenting was performed to visualize the position of the ampulla and to prevent post-ESD pancreatitis before ESD ([Fig. 2]). A duodenal adenoma was successfully resected en bloc with ESD. The post-ESD mucosal defect extended from the medial wall to the anterior wall. The anterior-wall defect was visualized with a transparent laparoscopic light, whereas no laparoscopic light was observed in the medial defect ([Fig. 3]). Subsequently, the anterior-wall defect was laparoscopically sutured from the serosal side, and the medial-wall defect was closed with line-attached clipping. Finally, the post-ESD mucosal defect was completely closed ([Fig. 4]). The resected tumor was pathologically diagnosed as high-grade dysplasia ([Fig. 5]). No adverse events were observed after the treatment. The pancreatic stent was endoscopically retrieved 2 months later.
Endoscopic line-attached clipping closure with laparoscopic suturing is a useful closure technique for duodenal post-ESD defects involving the medial wall ([Video 1]).
Video 1 Duodenal endoscopic submucosal dissection (ESD) followed by a complete closure of the post-ESD duodenal defects involving the medial wall.
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Article published online:
25 October 2021
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- 1 Kato M, Ochiai Y, Fukuhara S. et al. Clinical impact of closure of the mucosal defect after duodenal endoscopic submucosal dissection. Gastrointest Endosc 2019; 89: 87-93
- 2 Ichikawa D, Komatsu S, Dohi O. et al. Laparoscopic and endoscopic co-operative surgery for non-ampullary duodenal tumors. World J Gastroenterol 2016; 22: 10424-10431