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Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection

BACKGROUND: We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions. Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions. AIM: To elucidate the efficacy of the endoscopic mucosa-su...

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Autores principales: Kinoshita, Satoshi, Nishizawa, Toshihiro, Fujimoto, Ai, Mori, Hideki, Nakazato, Yoshihiro, Kikuchi, Masahiro, Uraoka, Toshio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939119/
https://www.ncbi.nlm.nih.gov/pubmed/31942230
http://dx.doi.org/10.4253/wjge.v12.i1.17
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author Kinoshita, Satoshi
Nishizawa, Toshihiro
Fujimoto, Ai
Mori, Hideki
Nakazato, Yoshihiro
Kikuchi, Masahiro
Uraoka, Toshio
author_facet Kinoshita, Satoshi
Nishizawa, Toshihiro
Fujimoto, Ai
Mori, Hideki
Nakazato, Yoshihiro
Kikuchi, Masahiro
Uraoka, Toshio
author_sort Kinoshita, Satoshi
collection PubMed
description BACKGROUND: We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions. Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions. AIM: To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection (ESD). METHODS: Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study. In this method, endo-clips are placed at the edges of a mucosal defect. Additional endo-clips are then applied in the same way to facilitate reduction of the defect size. Additional endo-clips are applied to both sides of the mucosal defect. Complete closure can be achieved. We have also developed a “location score” and “closure difficulty index” for assessment purposes. RESULTS: Complete closure was achieved in 68.2% of the patients (15/22). The location score in the failure group was significantly larger than that in the complete closure group (P = 0.023). The closure difficulty index in the failure group was significantly higher than that in the complete closure group (P = 0.007). When the cutoff value of the closure difficulty index was set at 99, the high closure difficulty index predicted failure with a sensitivity of 57.1%, specificity of 100%, and accuracy of 86.3%. CONCLUSION: The endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD, especially in cases with a high closure difficulty index.
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spelling pubmed-69391192020-01-16 Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection Kinoshita, Satoshi Nishizawa, Toshihiro Fujimoto, Ai Mori, Hideki Nakazato, Yoshihiro Kikuchi, Masahiro Uraoka, Toshio World J Gastrointest Endosc Retrospective Study BACKGROUND: We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions. Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions. AIM: To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection (ESD). METHODS: Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study. In this method, endo-clips are placed at the edges of a mucosal defect. Additional endo-clips are then applied in the same way to facilitate reduction of the defect size. Additional endo-clips are applied to both sides of the mucosal defect. Complete closure can be achieved. We have also developed a “location score” and “closure difficulty index” for assessment purposes. RESULTS: Complete closure was achieved in 68.2% of the patients (15/22). The location score in the failure group was significantly larger than that in the complete closure group (P = 0.023). The closure difficulty index in the failure group was significantly higher than that in the complete closure group (P = 0.007). When the cutoff value of the closure difficulty index was set at 99, the high closure difficulty index predicted failure with a sensitivity of 57.1%, specificity of 100%, and accuracy of 86.3%. CONCLUSION: The endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD, especially in cases with a high closure difficulty index. Baishideng Publishing Group Inc 2020-01-16 2020-01-16 /pmc/articles/PMC6939119/ /pubmed/31942230 http://dx.doi.org/10.4253/wjge.v12.i1.17 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Kinoshita, Satoshi
Nishizawa, Toshihiro
Fujimoto, Ai
Mori, Hideki
Nakazato, Yoshihiro
Kikuchi, Masahiro
Uraoka, Toshio
Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
title Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
title_full Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
title_fullStr Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
title_full_unstemmed Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
title_short Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
title_sort efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939119/
https://www.ncbi.nlm.nih.gov/pubmed/31942230
http://dx.doi.org/10.4253/wjge.v12.i1.17
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