Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5281-5286
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5281
Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration
Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki
Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan
Hirohito Mori, Department of Gastroenterological Surgery, Ehime Rosai Hospital, Niihama, Ehime 792-8550, Japan
Author contributions: Mori H was responsible for devising the research and writing the manuscript; Ayaki M, Kobara H, Fujihara S, Nishiyama N, Matsunaga T and Yachida T participated equally in the work; Masaki T provided a critical revision of the manuscript for intellectual content and was responsible for the final approval of the manuscript.
Ethics approval: The study was reviewed and approved by the Ethics Committee of Ehime Rosai Hospital, No. 40.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest: The authors declare no conflicts of interest, and no corporate financing was received.
Open-Access: 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. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hirohito Mori, MD, PhD, Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan. hiro4884@med.kagawa-u.ac.jp
Telephone: +81-87-8912156 Fax: +81-87-8912158
Received: October 16, 2014
Peer-review started: October 18, 2014
First decision: November 14, 2014
Revised: January 26, 2015
Accepted: March 19, 2015
Article in press: March 19, 2015
Published online: May 7, 2015
Processing time: 208 Days and 17.7 Hours
Abstract

AIM: To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures.

METHODS: Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed.

RESULTS: Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs.

CONCLUSION: If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs.

Keywords: Closure time; Endoscopic resection; Over-the-scope clip; Pancreatic juice; Bile acid

Core tip: Duodenal postoperative exposure of the artificial ulcer floor to pancreatic juice and bile acid induces delayed perforation. There are, however, no reports on comparisons of closure methods, closure times and medical costs according to the different methods for closure of artificial ulcer floors. If the post-endoscopic resection (ER) ulcer is under 20 mm in diameter, the conventional clip closure might be more suitable with regard to the prevention of delayed perforation and to medical costs. If the post-ER ulcer is over 20 mm, the over-the-scope clip closure should be selected with regard to safety and reliable closure even if there are high medical costs.