Aims:
Although endoscopic resection (ER) has been accepted as a standard treatment modality
for superficial non-ampullary duodenal tumor (SNADT) recently, it can cause adverse
events such as perforation and bleeding. The effect of prophylactic mucosal closure
after ER is controversial. The aim of this study was to investigate the efficacy of
prophylactic clipping for the prevention of delayed complications.
Methods:
We retrospectively reviewed medical records of patients who underwent ER for SNADT
from 3 centers. Patients were divided into 2 groups, immediate clipping group (ICG)
vs. no clipping group (NCG). Baseline characteristics and factors associated with
delayed complications such as size of the lesion, tumor location, histologic types,
and co-morbidities were compared between the two groups.
Results:
A total of 91 lesions from 91 patients were included in this study. Six patients underwent
ESD and 85 patients underwent EMR. Forty seven patients were allocated into ICG and
44 patients were allocated into NGC. Delayed bleeding occurred in 1 patient (2.1%)
and delayed perforation occurred in 1 patient (2.1%) among ICG. Delayed bleeding occurred
in 6 patients (13.6%, p = 0.053) and delayed perforation occurred in 3 patients (6.8%,
p = 0.350) in NCG. Delayed perforation were managed by laparoscopic simple closure
and delayed bleeding were managed by endoscopic hemostasis (n = 6) or embolization
(n = 1). There was no procedure related death.
Conclusions:
Although prophylactic clipping showed a tendency of low complication rates, further
studies with prospective design is anticipated.
