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Modified double-layered suturing after duodenal endoscopic submucosal dissection (ORIGAMI method)
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Teppei Masunaga1,
Motohiko Kato2,
Naohisa Yahagi1 |
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1Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, 2Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine |
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| Background: Duodenal endoscopic submucosal dissection (ESD) has a high risk of delayed adverse events; thus, complete mucosal defect closure is important. However, simple closure by endoscopic clips would create dead space under the mucosa and be unreliable. Recently, we developed modified double-layered suturing (ORIGAMI method; OGM), which can achieve robust closure even for large mucosal defects by folding the muscle layer using only endoscopic clips. This study aimed to evaluate the feasibility of this OGM in duodenal ESD. Methods: This retrospective observational study was conducted at a tertiary care hospital. We reviewed the cases of OGM attempted after duodenal ESD between June 2022 and March 2024. We excluded lesions located in bulbs and involving major papillae. We measured the clinical characteristics and outcomes of enrolled cases. Results: Sixty-one cases were enrolled. The most common location was the descending part of the duodenum (57%). The median mucosa defect size was 36 mm [range, 10-110]. Complete closure was achieved in 59 cases (97%), including the largest lesion. The median closure time was 14 min. Clips caused no perforations during closure. Delayed perforation and bleeding were not observed. Conclusion: The OGM achieved high-rate complete closure even after duodenal ESD, which could prevent delayed adverse events. |
Index Term 1: Modified double-layered suturing
Index Term 2: Duodenal endoscopic submucosal dissection
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