EFFECTIVENESS OF PROPHYLACTIC MUCOSAL CLOSURE AFTER DUODENAL ENDOSCOPIC SUBMUCOSAL DISSECTION TO PREVENT HAZARDOUS COMPLICATIONS

Aims:

The endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging because of anatomical specificities and, to date, has not been validated concerning the high rate of complications. Especially, postoperative complications such as delayed perforation and bleeding are often hazardous. The aims of this study were to clarify the feasibility and effectiveness of prophylactic closure for large mucosal defect after duodenal ESD using endoscopic closing technique such as endoloop method or grasping method.

Methods:

We analyzed 76 consecutive duodenal ESDs between February 2011 to November 2018. We divided the duodenal ESDs into 59 (77.6%) closure group (with prophylactic closure after ESD using clipping technique) and 17 (22.4%) non-closure groups. The outcomes (rate of general anesthesia, tumor/resection size, operation time, complete resection rate, delayed bleeding rate, cancer bearing rates and hospitalization days) were retrospectively analyzed.

Results:

There was no significant difference between the closure and non-closure groups about the cancer bearing rates (52.9% and 47.5%), mean operation time (203.6 and 147.3 min), complete resection rates (88.2% and 96.6%) and hospitalization (13.1 and 10.1days). The mean size of the tumor/resection was significantly smaller in closure group (20.9/29.5 mm) than in non-closure group (34.0/38.6 mm). The rate of general anesthesia was significantly higher in closure group (98.3%) than in non-closure group (88.2%). Delayed bleeding rate was significantly lower in closure group (1.7%) than that of non-closure group (23.5%). All patients with delayed bleeding were managed safely and successfully by coagulation using hemostatic forceps or clips. Delayed perforation occurred in only 1 patient in non-closure group, who required local closure and drainage of an abscess by open surgery.

Conclusions:

Endoscopic closing technique such as endoloop method or grasping method were feasible and reliable. Using those technique, the prophylactic mucosal closure after duodenal ESD could prevent the hazardous delayed complications.