Through-the-scope suture closure of nonampullary duodenal endoscopic mucosal resection defects: a retrospective multicenter cohort study.

Anand Kumar, Mouen A Khashab, Saowanee Ngamruengphong, Apurva Shrigiriwar, Hiroyuki Aihara, Raymond Kim, Andrew Canakis, Nikhil A Kumta, Peter V Draganov, Bashar Qumseya, Shailendra Singh, Alexander Schlachterman, Heiko Pohl, Jeffrey M Adler, Stuart Gordon, Andrew C Storm, Hemchand Ramberan, Gregory B Haber, Jonathan Cohen, Linda Y Zhang, Jose Antonio Almario

Journal: Endoscopy 2023;55(9):865-870

PMID: 37207666

Full Text on Georg Thieme Verlag Stuttgart, New York View on PubMed

Abstract

BACKGROUND

Delayed bleeding is among the most common adverse events associated with endoscopic mucosal resection (EMR) of nonampullary duodenal polyps. We evaluated the rate of delayed bleeding and complete defect closure using a novel through-the-scope (TTS) suturing system for the closure of duodenal EMR defects.

METHODS

We reviewed the electronic medical records of patients who underwent EMR for nonampullary duodenal polyps of ≥ 10 mm and prophylactic defect closure with TTS suturing between March 2021 and May 2022 at centers in the USA. We evaluated the rates of delayed bleeding and complete defect closure.

RESULTS

36 nonconsecutive patients (61 % women; mean [SD] age, 65 [12] years) underwent EMR of ≥ 10-mm duodenal polyps followed by attempted defect closure with TTS suturing. The mean (SD) lesion size was 29 (19) mm, defect size was 37 (25) mm; eight polyps (22 %) involved > 50 % of the lumen circumference. Complete closure was achieved in all cases (78 % with TTS suturing alone), using a median of one TTS suturing kit. There were no cases of delayed bleeding and no adverse events attributed to application of the TTS suturing device.

CONCLUSION

Prophylactic closure of nonampullary duodenal EMR defects using TTS suturing resulted in a high rate of complete closure and no delayed bleeding events.

Address: Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA.; Division of Gastroenterology and Hepatology, New York University School of Medicine, New York, New York, USA.; Virginia Gastroenterology Institute, Program in Endoscopic Oncology and Advanced Endoscopy, Suffolk, Virginia, USA.; Division of Gastroenterology and Hepatology, Mayo Clinic Minnesota, Rochester, Minnesota, USA.; Division of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.; Section of Gastroenterology, Veterans Affairs White River Junction, White River, Vermont, USA.; Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.; Division of Gastroenterology, West Virginia University Hospital, Morgantown, West Virginia, USA.; Gastroenterology, Hepatology, and Nutrition, University of Florida Health, Gainesville, Florida, USA.; Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.; Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.

DOI: 10.1055/a-2077-4832

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MeSH Terms: Humans, Female, Aged, Male, Endoscopic Mucosal Resection, Cohort Studies, Treatment Outcome, Duodenal Neoplasms, Retrospective Studies, Intestinal Polyps, Multicenter Studies as Topic