Original Article

Risk factors of delayed bleeding after endoscopic resection of superficial non-ampullary duodenal epithelial tumors and prevention by over-the-scope and conventional clipping

Corresponding Author

Ken Ohata

[email protected]

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

Corresponding: Ken Ohata, Division of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo 141-8625, Japan. Email: [email protected]

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Eiji Sakai,

Eiji Sakai

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Yuichiro Suzuki,

Yuichiro Suzuki

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Shunya Takayanagi,

Shunya Takayanagi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Marie Kurebayashi,

Marie Kurebayashi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Yoshiaki Kimoto,

Yoshiaki Kimoto

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Rindo Ishii,

Rindo Ishii

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Takafumi Konishi,

Takafumi Konishi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Kohei Ono,

Kohei Ono

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Tomoya Hirata,

Tomoya Hirata

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Keisuke Kanda,

Keisuke Kanda

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Maiko Takita,

Maiko Takita

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Ryoju Negishi,

Ryoju Negishi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Yohei Minato,

Yohei Minato

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Takashi Muramoto,

Takashi Muramoto

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Hitoshi Satodate,

Hitoshi Satodate

Department of, Surgery, NTT Medical Center Tokyo, Tokyo, Japan

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Masataka Taguri,

Masataka Taguri

Department of Data Science, Yokohama City University School of Data Science, Kanagawa, Japan

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Nobuyuki Matsuhashi,

Nobuyuki Matsuhashi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Ken Ohata,

Corresponding Author

Ken Ohata

[email protected]

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

Corresponding: Ken Ohata, Division of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo 141-8625, Japan. Email: [email protected]

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Eiji Sakai,

Eiji Sakai

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Yuichiro Suzuki,

Yuichiro Suzuki

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Shunya Takayanagi,

Shunya Takayanagi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Marie Kurebayashi,

Marie Kurebayashi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Yoshiaki Kimoto,

Yoshiaki Kimoto

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Rindo Ishii,

Rindo Ishii

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Takafumi Konishi,

Takafumi Konishi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Kohei Ono,

Kohei Ono

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Tomoya Hirata,

Tomoya Hirata

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Keisuke Kanda,

Keisuke Kanda

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Maiko Takita,

Maiko Takita

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Ryoju Negishi,

Ryoju Negishi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Yohei Minato,

Yohei Minato

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Takashi Muramoto,

Takashi Muramoto

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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Hitoshi Satodate,

Hitoshi Satodate

Department of, Surgery, NTT Medical Center Tokyo, Tokyo, Japan

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Masataka Taguri,

Masataka Taguri

Department of Data Science, Yokohama City University School of Data Science, Kanagawa, Japan

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Nobuyuki Matsuhashi,

Nobuyuki Matsuhashi

Departments of, Department of, Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan

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First published: 20 May 2020

https://doi.org/10.1111/den.13729

Citations: 27

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Abstract

Objectives

This study was aimed to reveal risk factors for delayed bleeding after endoscopic resection (ER) of superficial non-ampullary duodenal epithelial tumors (SNADETs) and at exploring measures to prevent this complication.

Methods

A total of 235 consecutive patients with 249 SNADETs who had undergone ER were enrolled in this study. They were divided into two groups: OTSC group, consisting of the initial 114 cases in which the defects were closed only using OTSCs; and OTSC-c group, consisting of the later 135 cases in which conventional clips were additionally used to cover the inverted submucosa after post-procedure defect closure using OTSCs. The therapeutic outcomes were then compared between the OTSC and OTSC-c groups.

Results

All lesions were successfully resected en-bloc, and the R0 resection rate was 92.4%. The complete defect closure rate was 90.0% and no delayed perforation occurred when successful defect closure was achieved. The rate of delayed bleeding was significantly higher in the OTSC group than in OTSC-c group (11.4% vs. 1.5%, P = 0.001). Multivariate logistic regression analyses revealed that tumor location distal to the ampulla (OR 10.0; 95% CI 1.24–81.0, P = 0.03) and use of a DOAC (OR 8.83; 95% CI 1.13–68.7, P = 0.04) were significant independent predictors of delayed bleeding. Propensity score-matching analysis revealed that additional use of conventional clips was associated with a significantly reduced risk of delayed bleeding (P = 0.003).

Conclusions

Additional use of conventional clips after prophylactic defect closure using OTSCs appears to be useful to reduce the risk of delayed bleeding after ER of SNADETs.

UMIN Clinical Trials (No. 000035478).

Conflict of interest

Authors declare no conflicts of interest for this article.

Supporting Information

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Volume33, Issue3

March 2021

Pages 390-398

Risk factors of delayed bleeding after endoscopic resection of superficial non-ampullary duodenal epithelial tumors and prevention by over-the-scope and conventional clipping

Abstract

Objectives

Methods

Results

Conclusions

Conflict of interest

Supporting Information

References

Citing Literature

References

Information

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Risk factors of delayed bleeding after endoscopic resection of superficial non-ampullary duodenal epithelial tumors and prevention by over-the-scope and conventional clipping

Abstract

Objectives

Methods

Results

Conclusions

Conflict of interest

Supporting Information

References

Citing Literature

References

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