Chung Jaeil, Wang Kelly, Podboy Alexander, Gaddam Srinivas, K Lo Simon
Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Clin Endosc. 2022 Jan;55(1):95-100. doi: 10.5946/ce.2020.281. Epub 2021 Mar 3.
BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) is the primary treatment for duodenal adenomas; however, it is associated with a high risk of perforation and bleeding, especially with larger lesions. The goal of this study was to demonstrate the feasibility and safety of endoscopic suturing (ES) for the closure of mucosal defects after duodenal EMR.
Consecutive adult patients who underwent ES of large mucosal defects after EMR of large (>2 cm) duodenal adenomas were retrospectively enrolled. The OverStitch ES system was employed for closing mucosal defects after EMR. Clinical outcomes and complications, including delayed bleeding and perforation, were documented.
During the study period, ES of mucosal defects was performed in seven patients in eight sessions (six for prophylaxis and two for the treatment of perforation). All ES sessions were technically successful. No early or delayed post-EMR bleeding was recorded. In addition, no clinically obvious duodenal stricture or recurrence was encountered on endoscopic follow-up evaluation, and no patients required subsequent surgical intervention.
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.
背景/目的：内镜黏膜切除术（EMR）是十二指肠腺瘤的主要治疗方法；然而，它与穿孔和出血的高风险相关，尤其是对于较大的病变。本研究的目的是证明内镜缝合（ES）用于十二指肠EMR后黏膜缺损闭合的可行性和安全性。
回顾性纳入连续的成年患者，这些患者在大的（>2 cm）十二指肠腺瘤EMR后接受了大黏膜缺损的ES。使用OverStitch ES系统在EMR后闭合黏膜缺损。记录临床结果和并发症，包括延迟出血和穿孔。
在研究期间，8次手术中对7例患者进行了黏膜缺损的ES（6例用于预防，2例用于治疗穿孔）。所有ES手术在技术上均获成功。未记录到EMR后早期或延迟出血。此外，在内镜随访评估中未遇到临床上明显的十二指肠狭窄或复发，且无患者需要后续手术干预。
ES用于预防和治疗EMR后十二指肠穿孔在技术上是可行、安全且有效的。ES应被视为预防或治疗与大十二指肠腺瘤EMR相关穿孔的一种选择。
