Management of a large mucosal defect after duodenal endoscopic resection

Table 1 Outcomes of duodenal endoscopic mucosal resection for non-ampullary duodenal neoplasm in the literature n (%)

Ref.	Year	Methods	No. lesions	Mean tumor size (mm)	En bloc resection rate	Operation time (min)	Perforation		Bleeding rate		Surgical conversion	Prophylactic closure
Hirasawa et al[31]	1997	EMR	14	12.7	12 (86)	-	0 (0)	-	0 (0)	-	0 (0)	-
Ahmad et al[32]	2002	EMR	27	-	23 (85)	-	0 (0)	-	9 (33)	-	0 (0)	Several patients with minor bleeding and resuming anticoagulants
Oka et al[33]	2003	EMR, polypectomy	15	9.4	-	-	0 (0)	-	1 (6)	-	0 (0)	-
Apel et al[34]	2005	EMR	20	Median 27.5	-	-	0 (0)	-	2 (10)	-	0 (0)	-
Lépilliez et al[16]	2008	EMR	43	19.0	21 (48.8)	-	1 (2.3)	Delayed (1)	11 (25.6)	Intraoperative (6), Delayed (5)	1 (2.3)	14 patients in which they were used for hemostasis or prevention by using either hemoclips or APC, no delayed bleeding was observed after the procedures
Alexander et al[35]	2009	EMR	23	27.6	18 (78)	-	0 (0)	-	1 (4)	Early (1)	0 (0)	2 patients with antiplatelet therapy by using hemoclip
Honda et al[23]	2009	EMR + EMRSH	6	7.5	5 (83)	15.8	0 (0)	-	1 (17)	Delayed (1)	1 (17)	-
Endo et al[44]	2010	EMR	11	9.5	10 (90.1)	-	0 (0)	-	0 (0)	-	0 (0)	-
Sohn et al[36]	2010	EMR, EMR-L, polypectomy	24	-	21 (87.5)	-	0 (0)	-	7 (29)	Intraoperative (7)	0 (0)	-
Kim et al[37]	2010	EMR	17	15.1	14 (82)	-	0 (0)	-	1 (6)	Delayed (1)	0 (0)	All cases with hemoclip and injection of 1:10000 epinephrin solution
Kedia et al[38]	2010	EMR	33	-	23 (69.7)	-	0 (0)	-	5 (14)	Intraoperative (5)	0 (0)	-
Conio et al[39]	2012	EMR-C	26	Median 15	-	30.0	0 (0)	-	3 (12)	Intraoperative (3)	0 (0)	-
Min et al[40]	2013	EMR	23	-	20 (87)	-	1 (4.3)	Immediate (1)	2 (8.7)	-	0 (0)	-
Fanning et al[50]	2013	EMR	50	-	25 (50)	-	2 (4)	Immediate (1), Delayed (1)	20 (40)	Intraoperative (17), Delayed (3)	2 (4)
Maruoka et al[17]	2013	EMR (including 7 cases with strip biopsy, 1 cases with ESD)	26	10.0	18 (69.2)	-	0 (0)	-	12 (46.2)	Intraoperative (9), Delayed (3)	0 (0)	19 lesions [19 (73.1)] with hemoclip
Matsumoto et al[5]	2014	EMR	31	11.4	26 (83.9)	13.2	0 (0)	-	1 (3.2)	Intraoperative (1)	0 (0)	24 cases of lesions [24 (77.4)] located in bulb and descending part of duodenum
Basford et al[51]	2014	EMR, hybrid EMR-ESD (including 1 case with ESD)	34	25.0	17 (50)	-	0 (0)		3 (8.8)	Delayed (3)	0 (0)	11 (32) of the 34 cases, clip were used to close the mucosal defect
Yamamoto et al[4]	2014	EMR	17	9.4	14 (82)	9.0	0 (0)	-	0 (0)	-	0 (0)	Limited cases of lesions located in the distal of duodenum with hemoclip
Kakushima et al[54]	2014	EMR, polypectomy	10	Median 15	10 (100)	-	0 (0)	-	0 (0)	-	0 (0)	-
Seo et al[41]	2014	EMR	33	-	-	-	0 (0)	-	2 (6)	Delayed (2)	0 (0)	-
Park et al[93]	2015	EMR	45	-	35 (77.8)	Median 13	2 (4.5)	-	1 (2.2)	Delayed (1)	-	-
Nonaka et al[29]	2015	EMR	113	Median 12	71 (63)	-	0 (0)	-	14 (12)	Delayed (14)	0 (0)	Immediate prophylactic closure was performed in 99 lesions [99 (81.8)] including 7 ESD cases with hemoclip

EMRSH: EMR with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate; EMR-L: EMR with ligation; EMR-C: Cap-assisted EMR; EMR: Endoscopic mucosal resection.

Table 2 Outcomes of duodenal endoscopic submucosal dissection for nonampullary duodenal neoplasm in the literature n (%)

Ref.	Year	No. lesions	Mean tumor size (mm)	R0 resection rate	Operation time (min)	Perforation		Delayed bleeding	Surgical conversion	Prophylactic closure
Honda et al[23]	2009	9	23.7	9 (100)	80.0	2 (22.2)	Immediate (1), delayed (1)	2 (22)	1 (11)	-
Takahashi et al[43]	2009	4	20.5	4 (100)	-	2 (50)	Immediate (2)	0 (0)	0 (0)	-
Endo et al[44]	2010	5	10.0	5 (100)	-	1 (20)	Immediate (1)	0 (0)	0 (0)	-
Jung et al[42]	2013	14	17.1	12 (85.7)	32.0	5 (35.7)	Immediate (3), delayed (2)	1 (7.1)	2 (14.3)	-
Matsumoto et al[5]	2014	15	12.9	13 (86.7)	86.5	3 (20)	Immediate (3)	3 (20)	2 (13.3)	4 of the 5 cases of lesion [4 (26.7)] located in descending part of the duodenum with hemoclip
Yamamoto et al[4]	2014	30	13.7	27 (90.0)	79.5	3 (10)	Immediate (2), delayed (1)	0 (0)	1 (3)	Limited cases of lesions located in the distal of duodenum with hemoclip
Seo et al[41]	2014	7	-	-	-	3 (75)	Immediate (3)	0 (0)	0 (0)	-
Kakushima et al[54]	2014	13	Median 13.5	13 (100)	-	4 (40)	Immediate (3), delayed (1)	0 (0)	1 (7.7)	-
Park et al[93]	2015	6	-	5 (83.3)	Median 41.5	2 (33.3)	-	0 (0)	-	-
Hoteya et al[15]	2015	63	24.6	55 (87.3)	116.4	21 (31.3)	-	11 (17.5)	4 (6.2)	23 patients [23 (36.5)] with hemoclip
Ishii et al[45]	2015	16	Median 13	13 (81.3)	Median 66	1 (6.3)	Immediate (1)	0 (0)	1 (6.3)	10 patients [10 (93)] with hemoclip (8 patients) and PGA sheets (2 patients)
Nonaka et al[29]	2015	8	Median 18	-	-	2 (25.0)	Delayed (1)	0 (0)	1 (12.5)	Immediate closure was performed in 99 lesions (99/121) including 113 EMR cases with hemoclip

PGA: Polyglycolic acid; EMR: Endoscopic mucosal resection.

Table 3 Outcome of duodenal endoscopic mucosal resection/endoscopic submucosal dissection in a previous multicenter questionnaire survey conducted in endoscopic submucosal dissection expert facilities in Japan

Ref.	Year	Methods	No. lesions	Perforation	Immediate perforation	Delayed perforation	Delayed bleeding	Surgical conversion
Ono et al[46]	2011	EMR	254	10 (3.9)	7 (2.8)	3 (1.2)	14 (5.5)	2 (0.8)
		ESD	167	42 (25)	32 (19)	10 (6.0)	14 (8.4)	9 (5.4)

EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection.