Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Division of Gastroenterology and Hepatology, New York University School of Medicine, New York, New York, USA.
Endoscopy. 2023 Sep;55(9):865-870. doi: 10.1055/a-2077-4832. Epub 2023 May 19.
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.
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.
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.
Prophylactic closure of nonampullary duodenal EMR defects using TTS suturing resulted in a high rate of complete closure and no delayed bleeding events.
延迟性出血是内镜下黏膜切除术（EMR）切除非壶腹十二指肠息肉后最常见的不良事件之一。我们评估了一种新型经内镜（TTS）缝合系统用于闭合十二指肠 EMR 缺损的延迟性出血和完全缺损闭合的发生率。
我们回顾了 2021 年 3 月至 2022 年 5 月期间，美国各中心接受 EMR 治疗的直径≥10mm 非壶腹十二指肠息肉且行 TTS 缝合预防性闭合的患者的电子病历。我们评估了延迟性出血和完全缺损闭合的发生率。
36 例非连续患者（61%为女性；平均[标准差]年龄，65[12]岁）接受 EMR 治疗直径≥10mm 的十二指肠息肉，随后尝试使用 TTS 缝合闭合缺损。平均（标准差）病变大小为 29（19）mm，缺损大小为 37（25）mm；8 个息肉（22%）累及>50%的管腔周长。所有病例均实现完全闭合（78%单独使用 TTS 缝合），使用中位数为 1 个 TTS 缝合套件。无延迟性出血病例，也无归因于 TTS 缝合装置应用的不良事件。
使用 TTS 缝合预防性闭合非壶腹十二指肠 EMR 缺损可实现较高的完全闭合率且无延迟性出血事件。
