Endoscopic Suturing for the Prevention and Treatment of Complications Associated with Endoscopic Mucosal Resection of Large Duodenal Adenomas
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Background/Aims: Endoscopic mucosal resection (EMR) is the primary treatment for duodenal adenomas; however, it is associatedwith a high risk of perforation and bleeding, especially with larger lesions. The goal of this study was to demonstrate the feasibilityand safety of endoscopic suturing (ES) for the closure of mucosal defects after duodenal EMR. Methods: Consecutive adult patients who underwent ES of large mucosal defects after EMR of large (>2 cm) duodenal adenomaswere retrospectively enrolled. The OverStitch ES system was employed for closing mucosal defects after EMR. Clinical outcomes andcomplications, including delayed bleeding and perforation, were documented. Results: During the study period, ES of mucosal defects was performed in seven patients in eight sessions (six for prophylaxisand two for the treatment of perforation). All ES sessions were technically successful. No early or delayed post-EMR bleeding wasrecorded. In addition, no clinically obvious duodenal stricture or recurrence was encountered on endoscopic follow-up evaluation,and no patients required subsequent surgical intervention. Conclusions: ES for the prevention and treatment of duodenal perforation after EMR is technically feasible, safe, and effective. ES should be considered an option for preventing or treating perforations associated with EMR of large duodenal adenomas.
Abstract
Background/Aims: Endoscopic mucosal resection (EMR) is the primary treatment for duodenal adenomas; however, it is associatedwith a high risk of perforation and bleeding, especially with larger lesions. The goal of this study was to demonstrate the feasibilityand safety of endoscopic suturing (ES) for the closure of mucosal defects after duodenal EMR. Methods: Consecutive adult patients who underwent ES of large mucosal defects after EMR of large (>2 cm) duodenal adenomaswere retrospectively enrolled. The OverStitch ES system was employed for closing mucosal defects after EMR. Clinical outcomes andcomplications, including delayed bleeding and perforation, were documented. Results: During the study period, ES of mucosal defects was performed in seven patients in eight sessions (six for prophylaxisand two for the treatment of perforation). All ES sessions were technically successful. No early or delayed post-EMR bleeding wasrecorded. In addition, no clinically obvious duodenal stricture or recurrence was encountered on endoscopic follow-up evaluation,and no patients required subsequent surgical intervention. Conclusions: ES for the prevention and treatment of duodenal perforation after EMR is technically feasible, safe, and effective. ES should be considered an option for preventing or treating perforations associated with EMR of large duodenal adenomas.
참고문헌 (31)
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