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.
