Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

摘要

Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer. Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer 20 mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184). Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p = .038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p = .07). The total procedure time was 96.6 +/- 28.2 and 72.8 +/- 24.2 (min) with a significant difference (p = .027). Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.