Song Y, Wang J, Meng F, Wu Q. Complete clip closure with staged triple-lumen feeding tube reduces delayed adverse events after duodenal endoscopic submucosal dissection. World J Gastroenterol 2026; 32(43): 121090 [DOI: 10.3748/wjg.121090]
Corresponding Author of This Article
Qi Wu, MD, Professor, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Endoscopy Center, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. wuqi1973@bjmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
Open-Access Policy of This Article
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/
World J Gastroenterol. Nov 21, 2026; 32(43): 121090 Published online Nov 21, 2026. doi: 10.3748/wjg.121090
Complete clip closure with staged triple-lumen feeding tube reduces delayed adverse events after duodenal endoscopic submucosal dissection
Yue Song, Jing Wang, Fan Meng, Qi Wu
Yue Song, Jing Wang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
Fan Meng, Department of Occupational Health and Environmental Health, School of Public Health, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang 050017, Hebei Province, China
Qi Wu, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
Co-first authors: Yue Song and Jing Wang.
Author contributions: Song Y and Wang J contributed equally to this manuscript and are co-first authors; Song Y designed the study, collected and analyzed data, and wrote the manuscript; Wang J was responsible for the methodology and project administration; Meng F performed the statistical analysis; Wu Q was responsible for the conceptualization and design of the study and acquisition of funding; and all authors read and approved the final version.
Supported by the Beijing Research Ward Excellence Program, No. BRWEP2024W032150100 and No. BRWEP2024W032150112; Hygiene and Health Development Scientific Research Fostering Plan of Haidian District, Beijing, No. HP2024-19-503002; Beijing Municipal Administration of Hospitals Incubating Program, No. PX2024041; and Application Demonstration and Promotion of Ultrasound/Confocal Endoscopy Technology in the Diagnosis and Treatment of Esophageal Tumors, No. 2023YFC2413802.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Peking University Cancer Hospital (approval No. 2017KT103).
Informed consent statement: All study participants, or their legal guardians, had provided informed written consent at the time of data collection.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The datasets used and/or analyzed during the current study are not publicly available due to patient privacy and ethical restrictions but are available from the corresponding author on reasonable request. The original contributions presented in the study are included in the article and the Supplementary material.
Corresponding author: Qi Wu, MD, Professor, State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Endoscopy Center, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. wuqi1973@bjmu.edu.cn
Received: March 17, 2026 Revised: April 10, 2026 Accepted: April 22, 2026 Published online: November 21, 2026 Processing time: 195 Days and 11 Hours
Abstract
BACKGROUND
Given the thin duodenal wall and exposure of post-resection defects to bile and pancreatic juice, delayed adverse events (AEs) after duodenal endoscopic submucosal dissection (ESD) remain a major clinical challenge. While insufficient defect closure and suboptimal postoperative drainage have been implicated as potential risk factors, real-world evidence remains limited. We hypothesized that complete clip closure combined with structured postoperative management using a triple-lumen feeding tube would reduce delayed AEs by improving defect protection and reducing exposure to digestive secretions.
AIM
To explore the relationship between complete clip closure, a staged postoperative management protocol, and delayed AEs after duodenal ESD.
METHODS
We retrospectively analyzed 179 consecutive patients who underwent duodenal ESD. The patients’ baseline characteristics were compared according to delayed AE occurrence. Independent risk factors for postoperative complications were identified through univariate and multivariate logistic regression analyses. Clip closure quality (complete vs incomplete) and postoperative management strategy (triple-lumen feeding tube vs nasogastric tube) effects on clinical outcomes were evaluated through subgroup analyses. The relationship between drainage strategy and perioperative inflammatory markers and nutritional indicators was examined through covariance analyses.
RESULTS
Delayed AEs occurred in 12.8% of patients. Multivariable analysis demonstrated that complete clip closure [adjusted odds ratio (aOR) = 0.16, 95% confidence interval (CI): 0.12-0.22; P < 0.001] and postoperative triple-lumen feeding tube placement (aOR = 0.64, 95%CI: 0.46-0.87; P < 0.001) were independently associated with lower delayed AEs risk. Patients who received complete closure and triple-lumen feeding tube drainage had the lowest observed incidence there of (2.8%). On postoperative day 1, the triple-lumen feeding tube group had a significantly lower neutrophil percentage than the nasogastric tube group [model 2: Adjusted mean difference (AMD) = -1.82], whereas serum albumin (model 2: AMD = 0.41) and total protein levels (model 2: AMD = 0.85) were significantly higher (all P < 0.05).
CONCLUSION
Complete clip closure and postoperative triple-lumen feeding tube management were independently associated with fewer delayed AEs after duodenal ESD.
Core Tip: Delayed adverse events (AEs) remain a major challenge after duodenal endoscopic submucosal dissection (ESD). In this real-world cohort, complete clip closure and postoperative triple-lumen feeding tube management were independently associated with fewer delayed AEs, with patients receiving both measures exhibiting the lowest observed complication rate. Furthermore, triple-lumen feeding tube drainage was associated with attenuated early postoperative inflammation and improved nutritional status. These results provide practical evidence to inform perioperative management in high-risk duodenal ESD.
