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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Effectiveness and safety of over-the-scope clip in closing perforations after duodenal surgery
Zhen-Zhen Wang, Xian-Bin Zhou, Yi Wang, Xin-Li Mao, Li-Ping Ye, Ling-Ling Yan, Ya-Hong Chen, Ya-Qi Song, Yue Cai, Shi-Wen Xu, Shao-Wei Li
Zhen-Zhen Wang, Xian-Bin Zhou, Yi Wang, Xin-Li Mao, Li-Ping Ye, Ling-Ling Yan, Ya-Qi Song, Yue Cai, Shao-Wei Li, Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Zhen-Zhen Wang, Xian-Bin Zhou, Yi Wang, Xin-Li Mao, Li-Ping Ye, Ling-Ling Yan, Ya-Qi Song, Yue Cai, Shao-Wei Li, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Ya-Hong Chen, Health Management Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Shi-Wen Xu, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
Author contributions: Wang ZZ, Zhou XB, Wang Y, Mao XL, and Ye LP participated in the clinical treatment; Xu SW, Yan LL, and Li SW wrote the original draft; Song YQ, Cai Y, and Chen YH undertook validation, writing, review, and editing; all authors contributed to the article and approved the submitted version.
Supported by Program of Taizhou Science and Technology Grant, No. 20ywb29; Medical Health Science and Technology Project of Zhejiang Province, No. 2021PY083 and No. 2019KY239; Key Technology Research and Development Program of Zhejiang Province, No. 2019C03040; Major Research Program of Taizhou Enze Medical Center Grant, No. 19EZZDA2; and Open Fund of Key Laboratory of Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, No. 21SZDSYS01 and No. 21SZDSYS09.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University Institutional Review Board (approval No. K20210412).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/ Corresponding author: Shao-Wei Li, PhD, Academic Fellow, Assistant Professor, Associate Research Scientist, Instructor, Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, No. 150 Xinmen Street, Linhai 317000, Zhejiang Province, China.
li_shaowei81@hotmail.com
Received: May 10, 2021
Peer-review started: May 10, 2021
First decision: June 27, 2021
Revised: July 8, 2021
Accepted: August 18, 2021
Article in press: August 18, 2021
Published online: September 21, 2021
Processing time: 128 Days and 2.3 Hours
BACKGROUND
Endoscopic resection of duodenal subepithelial lesions (SELs) is a difficult procedure with a high risk of perforation. At present, dealing with perforation after endoscopic resection of duodenal SELs is still considered a great challenge.
AIM
To evaluate the effectiveness and safety of an over-the-scope clip (OTSC) in the treatment of perforation post-endoscopic resection of duodenal SELs.
METHODS
From May 2015 to November 2019, 18 patients with perforation following endoscopic resection of duodenal SELs were treated with OTSCs. Data comprising the rate of complete resection, closure of intraprocedural perforation, delayed bleeding, delayed perforation, and postoperative infection were extracted.
RESULTS
The rate of complete removal of duodenal SELs and successful closure of the perforation was 100%. The median perforation size was 1 cm in diameter. Seventeen patients had minor intraoperative bleeding, while the remaining 1 patient had considerable amount of bleeding during the procedure. Seven patients had postoperative abdominal infections, of which 1 patient developed an abscess in the right iliac fossa and another patient developed septic shock. All 18 patients recovered and were discharged. No delayed bleeding or perforation was reported. The mean time taken to resume normal diet after the procedure was 6.5 d. The mean postoperative hospital stay was 9.5 d. No residual or recurrent lesions were detected during the follow-up period (15-66 mo).
CONCLUSION
Closing a perforation after endoscopic resection of duodenal SELs with OTSCs seems to be an effective and reasonably safe therapeutic method.
Core Tip: This study presents the use of over-the-scope clip in closing duodenal perforation of 18 patients. We believe that our study makes a significant contribution to the literature because dealing with perforation after endoscopic resection of duodenal subepithelial lesions is challenging. This study aimed to evaluate the effectiveness and safety of over-the-scope clip in closing perforation after endoscopic resection of duodenal subepithelial lesions. The rate of successful closure was 100%. No delayed perforation occurred in any of the patients. Seven patients had postoperative infection, of which 1 patient developed septic shock and underwent surgery. All 18 patients recovered.
