Clinical impact of closure of the mucosal defect after duodenal endoscopic submucosal dissection

Motohiko Kato, Yasutoshi Ochiai, Seiichiro Fukuhara, Tadateru Maehata, Motoki Sasaki, Yoshiyuki Kiguchi, Teppei Akimoto, Ai Fujimoto, Atsushi Nakayama, Takanori Kanai, Naohisa Yahagi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background and Aims: Delayed adverse events (bleeding or perforation) are major concerns associated with duodenal endoscopic submucosal dissection (ESD). The aim of this study was to assess the efficacy of prophylactic closure of the mucosal defect after duodenal ESD. Methods: This is a retrospective study from a university hospital. One hundred sixty-eight patients (173 lesions) who underwent duodenal ESD between July 2010 and June 2017 were included in this study. The study participants were divided into 3 subgroups according to the degree of closure: complete group, incomplete group, and unclosed group. The proportion of delayed adverse events, maximum serum level of C-reactive protein (CRP), and total length of hospital stay were compared among these subgroups. Moreover, a multivariate logistic regression model was constructed to identify the risk factors for delayed adverse events. Results: The proportion of delayed adverse events in the complete group, incomplete group, and unclosed group were 1.7%, 25%, and 15.6%, respectively. The difference between the complete group and the other groups was significant (P <.01). The maximum serum CRP level was much lower (1.51 ± 2.18 mg/dL vs 6.28 ± 10.0 mg/dL, P <.01), and the length of hospital stay was significantly shorter in the complete group than in the incomplete/unclosed group (median [range] 5 [5-14] days vs 8 [4-59] days, P <.01). Multivariate analysis revealed that complete closure had a significant decrease in delayed adverse events (odds ratio [OR], 0.055; 95% confidence interval [CI], 0.01-0.29; P <.01), and a lesion located distal from the descending part showed a statistical tendency to an increase in delayed adverse events (OR, 4.48; 95% CI, 0.85-23.6; P =.08). Conclusion: The present study revealed that complete closure of the mucosal defect after duodenal ESD significantly decreased the number of delayed adverse events and improved other outcomes.

Original languageEnglish
JournalGastrointestinal Endoscopy
DOIs
Publication statusAccepted/In press - 2018 Jan 1

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Length of Stay
C-Reactive Protein
Logistic Models
Odds Ratio
Confidence Intervals
Blood Proteins
Multivariate Analysis
Retrospective Studies
Hemorrhage
Endoscopic Mucosal Resection
Serum

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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Clinical impact of closure of the mucosal defect after duodenal endoscopic submucosal dissection. / Kato, Motohiko; Ochiai, Yasutoshi; Fukuhara, Seiichiro; Maehata, Tadateru; Sasaki, Motoki; Kiguchi, Yoshiyuki; Akimoto, Teppei; Fujimoto, Ai; Nakayama, Atsushi; Kanai, Takanori; Yahagi, Naohisa.

In: Gastrointestinal Endoscopy, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background and Aims: Delayed adverse events (bleeding or perforation) are major concerns associated with duodenal endoscopic submucosal dissection (ESD). The aim of this study was to assess the efficacy of prophylactic closure of the mucosal defect after duodenal ESD. Methods: This is a retrospective study from a university hospital. One hundred sixty-eight patients (173 lesions) who underwent duodenal ESD between July 2010 and June 2017 were included in this study. The study participants were divided into 3 subgroups according to the degree of closure: complete group, incomplete group, and unclosed group. The proportion of delayed adverse events, maximum serum level of C-reactive protein (CRP), and total length of hospital stay were compared among these subgroups. Moreover, a multivariate logistic regression model was constructed to identify the risk factors for delayed adverse events. Results: The proportion of delayed adverse events in the complete group, incomplete group, and unclosed group were 1.7{\%}, 25{\%}, and 15.6{\%}, respectively. The difference between the complete group and the other groups was significant (P <.01). The maximum serum CRP level was much lower (1.51 ± 2.18 mg/dL vs 6.28 ± 10.0 mg/dL, P <.01), and the length of hospital stay was significantly shorter in the complete group than in the incomplete/unclosed group (median [range] 5 [5-14] days vs 8 [4-59] days, P <.01). Multivariate analysis revealed that complete closure had a significant decrease in delayed adverse events (odds ratio [OR], 0.055; 95{\%} confidence interval [CI], 0.01-0.29; P <.01), and a lesion located distal from the descending part showed a statistical tendency to an increase in delayed adverse events (OR, 4.48; 95{\%} CI, 0.85-23.6; P =.08). Conclusion: The present study revealed that complete closure of the mucosal defect after duodenal ESD significantly decreased the number of delayed adverse events and improved other outcomes.",
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AU - Ochiai, Yasutoshi

AU - Fukuhara, Seiichiro

AU - Maehata, Tadateru

AU - Sasaki, Motoki

AU - Kiguchi, Yoshiyuki

AU - Akimoto, Teppei

AU - Fujimoto, Ai

AU - Nakayama, Atsushi

AU - Kanai, Takanori

AU - Yahagi, Naohisa

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AB - Background and Aims: Delayed adverse events (bleeding or perforation) are major concerns associated with duodenal endoscopic submucosal dissection (ESD). The aim of this study was to assess the efficacy of prophylactic closure of the mucosal defect after duodenal ESD. Methods: This is a retrospective study from a university hospital. One hundred sixty-eight patients (173 lesions) who underwent duodenal ESD between July 2010 and June 2017 were included in this study. The study participants were divided into 3 subgroups according to the degree of closure: complete group, incomplete group, and unclosed group. The proportion of delayed adverse events, maximum serum level of C-reactive protein (CRP), and total length of hospital stay were compared among these subgroups. Moreover, a multivariate logistic regression model was constructed to identify the risk factors for delayed adverse events. Results: The proportion of delayed adverse events in the complete group, incomplete group, and unclosed group were 1.7%, 25%, and 15.6%, respectively. The difference between the complete group and the other groups was significant (P <.01). The maximum serum CRP level was much lower (1.51 ± 2.18 mg/dL vs 6.28 ± 10.0 mg/dL, P <.01), and the length of hospital stay was significantly shorter in the complete group than in the incomplete/unclosed group (median [range] 5 [5-14] days vs 8 [4-59] days, P <.01). Multivariate analysis revealed that complete closure had a significant decrease in delayed adverse events (odds ratio [OR], 0.055; 95% confidence interval [CI], 0.01-0.29; P <.01), and a lesion located distal from the descending part showed a statistical tendency to an increase in delayed adverse events (OR, 4.48; 95% CI, 0.85-23.6; P =.08). Conclusion: The present study revealed that complete closure of the mucosal defect after duodenal ESD significantly decreased the number of delayed adverse events and improved other outcomes.

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