Effective and Secure Closure after Duodenal Endoscopic Submucosal Dissection: Combination of Endoscopic Ligation with O-Ring Closure and Over-the-Scope Clip
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Patients
2.2. Preoperative Endoscopic Examination
2.3. Duodenal ESD Procedure
2.4. B-OTSC Procedure
2.5. Post-ESD Follow-Up
2.6. Study Outcomes and Definition of AEs
2.7. Statistical Analysis
3. Results
3.1. Patients and ESD Procedures
3.2. Outcomes of B-OTSC
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | n = 9 |
---|---|
Age, mean ± SD, year | 67.2 (±9.3) |
Antithrombotic therapy, n (%) | |
LDA | 1 (11.1) |
Locations, n (%) | |
First portion | 0 (0) |
Second portion (oral Vater) | 5 (55.6) |
Second portion (anal Vater) | 4 (44.4) |
Third portion | 0 (0) |
Macroscopic findings, n (%) | |
Elevated | 8 (88.9) |
Depressed | 0 (0) |
Mixed | 1 (11.1) |
Occupied circumference, n (%) | |
≤49% | 6 (66.7) |
≥50% | 3 (33.3) |
En bloc resection, n (%) | 9 (100) |
R0 resection rate, n (%) | 9 (100) |
Tumor diameter, mean ± SD (range), mm | 26 (±5.7) |
Resected specimen diameter, mean ± SD (range), mm | 34.1 (±6.4) |
Procedure time, mean ± SD (range), min | 119.4 (±66.8) |
Intraoperative complications, n (%) | 0 (0) |
Adenoma, n (%) | 5 (55.6) |
Tubular adenocarcinoma, n (%) | 4 (44.4) |
Variables | n = 9 |
---|---|
Post-ESD complications (DB or DP) rate, n (%) | 0 (0) |
Complete closure rate, n (%) | 9 (100) |
Closure time of B-OTSC, mean ± SD (range), minutes | 53 (±21.6) |
Number of OTSC deployments, mean ± SD (range) | 1.4 (±0.5) |
Hospital stays after procedure, days, mean ± SD (range) | 7.8 (±1.8) |
AEs related to B-OTSC, n (%) | 0 (0) |
Sustained defect closure, n (%) | |
On POD3 | |
Sustained, n (%) | 8 (88.9) |
Partially sustained, n (%) | 1 (11.1) |
Unsustained, n (%) | 0 (0) |
On POD7 | |
Sustained, n (%) | 8 (88.9) |
Partially sustained, n (%) | 1 (11.1) |
Unsustained, n (%) | 0 (0) |
Patients | C-OTSC (n = 11) | B-OTSC (n = 9) | p Value |
---|---|---|---|
Age, mean ± SD, year | 65 (±7.8) | 67.2 (±9.3) | p = 0.31 * |
Antithrombotic therapy, n (%) | p = 0.45 # | ||
LDA | 0 (0) | 1 (11.1) | |
Tumor diameter, mean ± SD (range), mm | 16.5 (±6.1) | 26 (±5.7) | p < 0.01 * |
Resected specimen diameter, mean ± SD (range), mm | 27.3 (±7.6) | 34.1 (±6.4) | p = 0.036 * |
Locations, n (%) | p = 0.44 # | ||
First portion | 1 (9.1) | 0 (0) | |
Second portion (oral Vater) | 3 (27.3) | 5 (55.6) | |
Second portion (anal Vater) | 6 (54.5) | 4 (44.4) | |
Third portion | 1 (9.1) | 0 (0) | |
Occupied circumference, n (%) | p = 0.18 # | ||
≤49% | 10 (90.9) | 6 (66.7) | |
≥50% | 1 (9.1) | 3 (33.3) | |
Post-ESD complications (DB or DP) rate, n (%) | 1 (9.1) | 0 (0) | p = 0.35 # |
Closure time, mean ± SD (range), minutes | 36.8 (±17) | 53 (±21.6) | p = 0.087 * |
The approximate ellipsoid resected area (An) (cm2), mean ± SD (range) | 469.6 (±294.3) | 625.9 (±217.4) | p = 0.12 * |
The closed area per minute (DAn) (cm2/min), mean ± SD (range) | 13.9 (±8) | 12.9 (±5.6) | p = 0.43 * |
Complete closure rate, n (%) | 11 (100) | 9 (100) | p = 1 # |
Number of cases with 1/2/3 clips, n (%) | 5(45.5)/3(27.3)/3(27.3) | 6(66.7)/3(33.3)/0 | p = 0.38 # |
Hospital stay after procedure, days, mean ± SD (range) | 8.7 (±3.4) | 7.8 (±1.8) | p = 0.41 * |
Adverse events related to closure, n (%) | 0 (0) | 0 (0) | p = 1 # |
Cost (¥)/($), mean | 237,000/1760 | 120,900/900 | p < 0.01 * |
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Nakatani, K.; Kobara, H.; Nishiyama, N.; Fujihara, S.; Tada, N.; Koduka, K.; Matsui, T.; Chiyo, T.; Kobayashi, N.; Yachida, T.; et al. Effective and Secure Closure after Duodenal Endoscopic Submucosal Dissection: Combination of Endoscopic Ligation with O-Ring Closure and Over-the-Scope Clip. J. Clin. Med. 2023, 12, 4238. https://doi.org/10.3390/jcm12134238
Nakatani K, Kobara H, Nishiyama N, Fujihara S, Tada N, Koduka K, Matsui T, Chiyo T, Kobayashi N, Yachida T, et al. Effective and Secure Closure after Duodenal Endoscopic Submucosal Dissection: Combination of Endoscopic Ligation with O-Ring Closure and Over-the-Scope Clip. Journal of Clinical Medicine. 2023; 12(13):4238. https://doi.org/10.3390/jcm12134238
Chicago/Turabian StyleNakatani, Kaho, Hideki Kobara, Noriko Nishiyama, Shintaro Fujihara, Naoya Tada, Kazuhiro Koduka, Takanori Matsui, Taiga Chiyo, Nobuya Kobayashi, Tatsuo Yachida, and et al. 2023. "Effective and Secure Closure after Duodenal Endoscopic Submucosal Dissection: Combination of Endoscopic Ligation with O-Ring Closure and Over-the-Scope Clip" Journal of Clinical Medicine 12, no. 13: 4238. https://doi.org/10.3390/jcm12134238
APA StyleNakatani, K., Kobara, H., Nishiyama, N., Fujihara, S., Tada, N., Koduka, K., Matsui, T., Chiyo, T., Kobayashi, N., Yachida, T., Tani, J., Morishita, A., Isomoto, H., & Masaki, T. (2023). Effective and Secure Closure after Duodenal Endoscopic Submucosal Dissection: Combination of Endoscopic Ligation with O-Ring Closure and Over-the-Scope Clip. Journal of Clinical Medicine, 12(13), 4238. https://doi.org/10.3390/jcm12134238