Endoscopy 2018; 50(05): 487-496
DOI: 10.1055/s-0044-102255
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Tomoaki Tashima
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Ken Ohata
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Eiji Sakai
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Yoshitsugu Misumi
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Maiko Takita
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Yohei Minato
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Yasushi Matsuyama
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Takashi Muramoto
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Hitoshi Satodate
Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan
,
Hajime Horiuchi
Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan
,
Nobuyuki Matsuhashi
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
,
Kouichi Nonaka
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
,
Shomei Ryozawa
Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
› Author Affiliations
TRIAL REGISTRATION: registered as a single-center, prospective, interventional trial UMIN 000022435 at http://www.umin.ac.jp
Further Information

Publication History

submitted 16 August 2017

accepted after revision 10 December 2017

Publication Date:
02 March 2018 (eFirst)

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.