Clin Endosc.  2022 Jan;55(1):95-100. 10.5946/ce.2020.281.

Endoscopic Suturing for the Prevention and Treatment of Complications Associated with Endoscopic Mucosal Resection of Large Duodenal Adenomas

• Chung J
• Wang K
• Podboy A
• Gaddam S
• K. Lo S

• KMID: 2525055
• DOI: http://doi.org/10.5946/ce.2020.281

Abstract

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.
Methods
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.
Results
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.
Conclusions
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.

Keyword

Duodenal adenoma; Endoscopic mucosal resection; Endoscopic suturing

Figure

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  Fig. 1. (A) A 30-mm duodenal adenoma located in the junction of the second and third duodenum. (B) After duodenal endoscopic mucosal resection, prophylactic OverStitch endoscopic suturing was performed. (C) One of the three sutures was loose, and duodenal perforation was observed 5 hours later. (D) The second OverStitch endoscopic suturing was performed. (E) The perforation site was closed using three separate OverStitch endoscopic stitches. (F) Fluoroscopy showed no dye leakage through the duodenum.

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  Fig. 2. (A) A 20-mm duodenal adenoma located in the anterior wall of the second part of the duodenum. (B) After duodenal endoscopic mucosal resection. (C) Prophylactic closure was first attempted through endoscopic clip application; however, it failed owing to a large diastasis between the edges and the tangential application. OverStitch endoscopic suturing was then performed with interrupted stitches. (D) The closure of the defect with OverStitch endoscopic suturing.

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