Clin Endosc.  2021 Jul;54(4):563-569. 10.5946/ce.2020.109.

The Use of Endoscopic Clipping in Preventing Delayed Complications after Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumors

• An JY
• Kim BW
• Kim JS
• Park JM
• Kim TH
• Lee J

• KMID: 2518860
• DOI: http://doi.org/10.5946/ce.2020.109

Abstract

Background/Aims
Endoscopic resection (ER) has recently been accepted as the standard treatment modality for superficial nonampullary duodenal tumors (SNADTs). However, the procedure can cause adverse events such as perforation and bleeding. This study aimed to investigate the efficacy of prophylactic clipping in the prevention of delayed complications.
Methods
A retrospective review of the medical records of patients who underwent ER for SNADT from 3 centers was performed. Patients were divided into 2 groups: the immediate clipping group (ICG) and the no clipping group (NCG). Various baseline characteristics and factors associated with the appearance of delayed complications, such as size of the lesion, tumor location, histologic type, and co-morbidities, were compared between the two groups.
Results
A total of 99 lesions from 99 patients were included in this study. Fifty-two patients were allocated into ICG and 47 patients were allocated into NCG. Delayed bleeding occurred in 1 patient from ICG and in 8 patients from NCG. Delayed perforation occurred in 1 patient from ICG and in 3 patients from NCG. There were no procedure-related deaths in both groups.
Conclusions
Although the use of endoscopic clipping seemed to reduce the risk of developing delayed complications, further studies using a prospective design is required.

Keyword

Clipping; Complication; Endoscopic resection; Non-ampullary duodenal tumor

Figure

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  Fig. 1. Flow diagram of this study. GIST, gastrointestinal stromal tumor.

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  Fig. 2. Endoscopic clipping after endoscopic mucosal resection for duodenal adenoma. (A) An adenoma is found at the second portion of the duodenum (white arrow heads). (B) Endoscopic mucosal resection with snare is performed. (C) A mucosal defect is noted after endoscopic mucosal resection (white arrow heads). (D) The mucosal defect is closed using an endoscopic clipping device.

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