Efficacy of mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection  

作　　者：Satoshi Kinoshita Toshihiro Nishizawa Ai Fujimoto Hideki Mori Yoshihiro Nakazato Masahiro Kikuchi Toshio Uraoka 

机构地区：[1]Department of Gastroenterology,National Hospital Organization Tokyo Medical Center,Tokyo 152-8902,Japan [2]Division of Research and Development for Minimally Invasive Treatment,Cancer Center,Keio University School of Medicine,Tokyo 160-8582,Japan [3]Department of Gastroenterology and Hepatology,International University of Health and Welfare Mita Hospital,Tokyo 108-8329,Japan [4]Department of Internal Medicine,Division of Gastroenterology and Hepatology,Gunma University,Maebashi 371-8511,Japan

出　　处：《World Journal of Gastrointestinal Endoscopy》2020年第1期17-22,共6页世界胃肠内镜杂志（英文版）（电子版）

摘　　要：BACKGROUND We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions.Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions.AIM To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection(ESD).METHODS Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study.In this method,endo-clips are placed at the edges of a mucosal defect.Additional endo-clips are then applied in the same way to facilitate reduction of the defect size.Additional endo-clips are applied to both sides of the mucosal defect.Complete closure can be achieved.We have also developed a“location score”and“closure difficulty index”for assessment purposes.RESULTS Complete closure was achieved in 68.2%of the patients(15/22).The location score in the failure group was significantly larger than that in the complete closure group(P=0.023).The closure difficulty index in the failure group was significantly higher than that in the complete closure group(P=0.007).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%.CONCLUSION The endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD,especially in cases with a high closure difficulty index.BACKGROUND We recently developed a new endoscopic closure technique using only conventional endo-clips for colorectal lesions.Little is known about the feasibility of the endoscopic mucosa-submucosa clip closure method for gastric lesions.AIM To elucidate the efficacy of the endoscopic mucosa-submucosa clip closure method after gastric endoscopic submucosal dissection(ESD).METHODS Twenty-two patients who underwent gastric ESD and mucosa-submucosa clip closure were included in this study.In this method,endo-clips are placed at the edges of a mucosal defect.Additional endo-clips are then applied in the same way to facilitate reduction of the defect size.Additional endo-clips are applied to both sides of the mucosal defect.Complete closure can be achieved.We have also developed a "location score" and "closure difficulty index" for assessment purposes.RESULTS Complete closure was achieved in 68.2% of the patients(15/22).The location score in the failure group was significantly larger than that in the complete closure group(P = 0.023).The closure difficulty index in the failure group was significantly higher than that in the complete closure group(P = 0.007).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%.CONCLUSION The endoscopic mucosa-submucosa clip closure method was unreliable after gastric ESD,especially in cases with a high closure difficulty index.

关 键 词：Endoscopic submucosal dissection STOMACH Endoscopic mucosa-submucosa clip closure method Colorectal 

分 类 号：R73[医药卫生—肿瘤]