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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jan 16, 2020; 12(1): 17-22
Published online Jan 16, 2020. doi: 10.4253/wjge.v12.i1.17
Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection
Satoshi Kinoshita, Toshihiro Nishizawa, Ai Fujimoto, Hideki Mori, Yoshihiro Nakazato, Masahiro Kikuchi, Toshio Uraoka
Satoshi Kinoshita, Toshihiro Nishizawa, Ai Fujimoto, Hideki Mori, Yoshihiro Nakazato, Masahiro Kikuchi, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan
Satoshi Kinoshita, Toshihiro Nishizawa, Ai Fujimoto, Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo 160-8582, Japan
Toshihiro Nishizawa, Department of Gastroenterology and Hepatology, International University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
Toshio Uraoka, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Gunma University, Maebashi 371-8511, Japan
Author contributions: All authors helped to perform the research; Kinoshita S and Nishizawa T contributed to manuscript writing and data analysis; Kinoshita S, Nishizawa T, Fujimoto A and Mori H performed the procedures; Nakazato Y and Kikuchi M recruited the patients; Uraoka T developed the mucosa-submucosa clip closure method.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Tokyo Medical Center.
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
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/
Corresponding author: Toshihiro Nishizawa, MD, PhD, Doctor, Department of Gastroenterology and Hepatology, International University of Health and Welfare Mita Hospital, Mita 1-4-3 Minato-ku, Tokyo 108-8329, Japan. nisizawa@kf7.so-net.jp
Received: May 15, 2019
Peer-review started: May 20, 2019
First decision: August 2, 2019
Revised: August 30, 2019
Accepted: November 6, 2019
Article in press: November 6, 2019
Published online: January 16, 2020
ARTICLE HIGHLIGHTS
Research background
We recently developed the endoscopic mucosa-submucosa clip closure method for mucosal defects after endoscopic submucosal dissection (ESD). The method is a simple closure method using only conventional clips.
Research motivation
The endoscopic mucosa-submucosa clip closure method is feasible for colorectal mucosal defects. However, the feasibility for gastric mucosal defects is still unknown.
Research objectives
The aim of this retrospective study was to elucidate the efficacy of endoscopic mucosa-submucosa clip closure method for gastric mucosal defects.
Research methods
Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were investigated in this study. The difficulty in closing the defects was assessed by the newly developed “location score” and “closure difficulty index”. “Closure difficulty index” was defined as: “size of the resected specimen (mm)” × “location score.” In the “location score”, the area with thick gastric wall and lateral view approach was scored as 3; the area with thin gastric wall and front view approach was scored as 1; other areas were scored as 2.
Research results
The success rate was 68.2% (15/22). The failure group had a significantly higher location score (P = 0.023) and closure difficulty index (P = 0.007) than the complete closure group. 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%.
Research conclusions
The endoscopic mucosa-submucosa clip closure method after gastric ESD would fail in cases with a high closure difficulty index.
Research perspectives
The endoscopic mucosa-submucosa clip closure method is effective in completely closing mucosal defects as large as 2-4 cm in diameter after colorectal ESD.
