Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Gastroenterol Hepatol. 2024 Apr;39(4):725-732. doi: 10.1111/jgh.16464. Epub 2024 Jan 16.
Prophylactic closure with the over-the-scope clip (OTSC) after endoscopic submucosal dissection (ESD) of superficial non-ampullary duodenal epithelial tumors (SNADETs) has been reported to reduce postoperative adverse events (AEs). However, there are few evidences regarding AEs-associated factors and long-term outcomes of OTSCs.
From January 2011 to December 2020, 139 consecutive patients with SNADETs who underwent ESD followed by OTSC closure in five institutions were extracted in this retrospective study. The primary endpoint was the rate of postoperative AEs after prophylactic OTSC closure. The secondary endpoints were the complete closure rate, residual rate, and long-term AEs associated with residual OTSCs.
The rate of complete closure of the mucosal defect was 97.3% (142) in 146 SNADETs, which were completely resected by ESD. Postoperative AEs, including delayed bleeding, delayed perforation, and localized peritonitis, occurred in 6.2%, 3.4%, and 2.1% of patients, respectively; however, all of the cases improved without surgical treatment. In the multivariate logistic regression analysis, the use of two or more OTSCs was a significant independent risk factor for postoperative AEs (odds ratio, 2.94; 95% confidence interval, 1.02-8.46; P = 0.046). The residual OTSC rate was 46.4% at 1 year postoperatively, and long-term AEs included duodenal erosions and ulcers associated with residual OTSCs.
Prophylactic closure with OTSCs after duodenal ESD can provide acceptable short-and long-term outcomes for preventing postoperative AEs. However, multiple OTSCs were the independent risk factors of postoperative AEs due to the gaps between and near the OTSCs.
内镜黏膜下剥离术（ESD）治疗非壶腹型十二指肠黏膜上皮肿瘤（SNADETs）后，使用内镜下全覆膜金属夹（OTSC）预防性夹闭已被报道可降低术后不良事件（AEs）的发生率。然而，关于 OTSC 相关 AEs 的影响因素和长期结局的证据较少。
本回顾性研究纳入了 2011 年 1 月至 2020 年 12 月在五家机构接受 ESD 联合 OTSC 预防性夹闭治疗的 139 例 SNADETs 患者。主要终点是预防性 OTSC 夹闭术后 AEs 的发生率。次要终点是黏膜缺损的完全闭合率、残留率以及与残留 OTSC 相关的长期 AEs。
146 例完全切除的 SNADETs 中，黏膜缺损完全闭合率为 97.3%（142/146）。术后 AEs 包括延迟性出血、延迟性穿孔和局限性腹膜炎，发生率分别为 6.2%、3.4%和 2.1%；然而，所有患者均未经手术治疗而改善。多变量逻辑回归分析显示，使用两个或更多 OTSC 是术后 AEs 的显著独立危险因素（比值比，2.94；95%置信区间，1.02-8.46；P=0.046）。术后 1 年时，残留 OTSC 率为 46.4%，长期 AEs 包括与残留 OTSC 相关的十二指肠糜烂和溃疡。
十二指肠 ESD 后使用 OTSC 预防性夹闭可获得可接受的短期和长期结局，以预防术后 AEs。然而，由于 OTSC 之间和附近存在间隙，多个 OTSC 是术后 AEs 的独立危险因素。
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