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.

中文翻译：

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十二指肠内镜黏膜下剥离术对粘膜缺损闭合的临床影响

背景和目标

延迟的不良事件（出血或穿孔）是与十二指肠内镜下黏膜下剥离术（ESD）相关的主要问题。这项研究的目的是评估十二指肠ESD预防性闭合粘膜缺损的功效。

方法

这是大学医院的一项回顾性研究。这项研究纳入了2010年7月至2017年6月间接受十二指肠ESD的168例患者（173个病灶）。根据封闭程度将研究参与者分为3个亚组：完全组，不完全组和未封闭组。在这些亚组中比较了延迟不良事件的比例，C反应蛋白（CRP）的最高血清水平和住院总时间。此外，构建了多元逻辑回归模型以识别延迟不良事件的危险因素。

结果

完全组，不完全组和未闭合组的迟发不良事件所占比例分别为1.7％，25％和15.6％。完整组与其他组之间的差异是显着的（P  <.01）。最高血清CRP水平要低得多（1.51±2.18 mg / dL与6.28±10.0 mg / dL，P  <.01），完整组的住院时间明显少于不完全/未封闭组（中位数[范围] 5 [5-14]天与8 [4-59]天，P  <0.01）。多变量分析显示，完全封闭治疗可显着降低延迟不良事件的发生率（几率[OR]为0.055； 95％置信区间[CI]为0.01-0.29；P <.01），并且位于下降部分远端的病变在统计学上显示出延迟不良事件增加的趋势（OR，4.48； 95％CI，0.85-23.6；P  = .08）。

结论

本研究表明，十二指肠ESD后粘膜缺损的完全闭合显着减少了延迟不良事件的数量并改善了其他结局。