Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study

Abstract

Background Delayed bleeding is among the most common adverse events associated with endoscopic mucosal resection (EMR) of nonampullary duodenal polyps. We evaluated the rate of delayed bleeding and complete defect closure using a novel through-the-scope (TTS) suturing system for the closure of duodenal EMR defects.

Methods We reviewed the electronic medical records of patients who underwent EMR for nonampullary duodenal polyps of ≥ 10 mm and prophylactic defect closure with TTS suturing between March 2021 and May 2022 at centers in the USA. We evaluated the rates of delayed bleeding and complete defect closure.

Results 36 nonconsecutive patients (61 % women; mean [SD] age, 65 [12] years) underwent EMR of ≥ 10-mm duodenal polyps followed by attempted defect closure with TTS suturing. The mean (SD) lesion size was 29 (19) mm, defect size was 37 (25) mm; eight polyps (22 %) involved > 50 % of the lumen circumference. Complete closure was achieved in all cases (78 % with TTS suturing alone), using a median of one TTS suturing kit. There were no cases of delayed bleeding and no adverse events attributed to application of the TTS suturing device.

Conclusion Prophylactic closure of nonampullary duodenal EMR defects using TTS suturing resulted in a high rate of complete closure and no delayed bleeding events.

Publikationsverlauf

Eingereicht: 20. Oktober 2022

Angenommen nach Revision: 10. März 2023

Artikel online veröffentlicht:
19. Mai 2023

• References

• 1 Culver E, McIntyre A. Sporadic duodenal polyps: classification, investigation, and management. Endoscopy 2011; 43: 144-155
• 2 Galandiuk S, Hermann RE, Sivak MV. et al. Villous tumors of the duodenum. Ann Surg 1988; 207: 234-239
• 3 Vanbiervliet G, Moss A, Arvanitakis M. et al. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 522-534
• 4 Apel D, Jakobs R, Spiethoff A. et al. Follow-up after endoscopic snare resection of duodenal adenomas. Endoscopy 2005; 37: 444-448
• 5 Alexander S, Bourke MJ, Williams SJ. et al. EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc 2009; 69: 66-73
• 6 Abbass R, Rigaux J, Al-Kawas FH. Nonampullary duodenal polyps: characteristics and endoscopic management. Gastrointest Endosc 2010; 71: 754-759
• 7 Klein A, Nayyar D, Bahin FF. et al. Endoscopic mucosal resection of large and giant lateral spreading lesions of the duodenum: success, adverse events, and long-term outcomes. Gastrointest Endosc 2016; 84: 688-696
• 8 Yamasaki Y, Uedo N, Iishi H. et al. Underwater endoscopic mucosal resection for superficial nonampullary duodenal adenomas. Endoscopy 2018; 50: 154-158
• 9 Maruoka D, Arai M, Yokosuka O. et al. Clinical outcomes of endoscopic resection for nonampullary duodenal high-grade dysplasia and intramucosal carcinoma. Endoscopy 2013; 45: 138-141
• 10 Pohl H, Grimm I, Rex D. et al. Clip closure prevents bleeding after endoscopic resection of large colon polyps in a randomized trial. Gastroenterology 2019; 157: 977-984.e3
• 11 Liaquat H, Rohn E, Rex D. et al. Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage: experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions. Gastrointest Endosc 2013; 77: 401-407
• 12 Feagins LA, Smith A, Spechler S. et al. Efficacy of prophylactic hemoclips in prevention of delayed post-polypectomy bleeding in patients with large colonic polyps. Gastroenterology 2019; 157: 967-976.e1
• 13 Tsutsumi K, Kato M, Sho M. et al. Efficacy of endoscopic preventive procedures to reduce delayed adverse events after endoscopic resection of superficial nonampullary duodenal epithelial tumors: a meta-analysis of observational comparative trials. Gastrointest Endosc 2021; 93: 367-374.e3
• 14 Chung J, Wang K, Lo KS. et al. Endoscopic suturing for the prevention and treatment of complications associated with endoscopic mucosal resection of large duodenal adenomas. Clin Endosc 2022; 55: 95-100
• 15 Tashima T, Ryozawa S, Tanisaka Y. et al. Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors. Endosc Int Open 2021; 9: E659-E666
• 16 Mahmoud T, Wong Kee Song LM, Stavropoulos SN. et al. Initial multicenter experience using a novel endoscopic tack and suture system for challenging GI defect closure and stent fixation (with video). Gastrointest Endosc 2022; 95: 373-382
• 17 Zhang LY, Bejjani M, Khashab MA. Endoscopic through-the-scope suturing. VideoGIE 2022; 7: 46-51
• 18 Cotton PB, Eisen GM, Vargo JJ. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 19 Yamasaki Y, Uedo N, Iishi H. et al. Current status of endoscopic resection for superficial nonampullary duodenal epithelial tumors. Digestion 2018; 97: 45-51
• 20 Hagel AF, Naegel A, Lindner AS. et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg 2012; 16: 2132-2138