111 EFFICACY AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION WITH OVER-THE-SCOPE-CLIP CLOSURE FOR SUPERFICIAL NON-AMPULLARY DUODENAL EPITHELIAL TUMOR

Abstract

Endoscopic treatment such as endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal epithelial tumor (SNADET) is often caused high rate of delayed complications. We reported that laparoscopic and endoscopic co-operative surgery (LECS) is one of the minimally invasive treatments for SNADET. LECS can prevent delayed complications due to laparoscopic closure. In contrast, there have been some reports with regard to the usefulness of the over-the-scope clip (OTSC) for prevention of delayed complications after endoscopic treatment. The aim of this study was to assess the safety and feasibility of ESD with OTSC closure for SNADET compared with LECS. The patients who underwent ESD with OTSC closure (ESD-OTSC) and LECS at the hospital of Kyoto Prefectural University of Medicine were enrolled between 2015 and 2017. The indication for these procedures was the presence of SNADETs with a low risk for lymph node metastasis. In particular, the tumors included epithelial mucosal tumors, such as mucosal cancers or large mucosal adenomas with malignant suspicion. The LECS procedure is laparoscopic reinforcement after ESD for SNADETs. The primary endpoint was the rate of en block resection, delayed complications (perforation and bleeding), and residual tumor 3 months after the resection. All patients provided written informed consent. This study was approved by the ethical committee of Kyoto Prefectural University of Medicine. A total of 11 and 22 lesions in 10 and 21 patients (male/female 5/5:12/9, median age 71:63 years) were resected by LECS and ESD-OTSC between 2015 and 2017, respectively. In LECS and ESD-OTSC cases, lesion’s location was first/2nd/third portion 2/8/1 and 4/18/0, median lesion’s size was 23.6 and 16.2mm (range 7-40 and 12-24), and macroscopic type was elevated type/ depressed type 10/1 and 16/6, respectively, with no significant difference. Median tumor size in LECS and ESD-OTSC cases was 14.5 and 23.7 mm (range 7-40 and 13-38 mm), and the rate of R0 resection was 81.8 and 95.5%, respectively, with no significant difference. Median procedure time in ESD-OTSC cases was significantly shorter than that in LECS cases (47 min, range 15-135 min and 104 min, range 20-225 min, respectively, P< 0.01). No delayed complications (bleeding and perforation) were also observed in all cases. Histopathological diagnosis (adenoma/ T1a cancer/ T1b cancer) in LECS and ESD-OTSC cases revealed 1/9/1 and 1/19/2, respectively. No local recurrence was detected endoscopically in all cases 2 months later. ESD with OTSC closure for SNADET could be a safe procedure with a shorter procedure time compared to LECS.