Feasibility of modified double-layered suturing for a large mucosal defect after duodenal endoscopic submucosal dissection (origami method)

Abstract

Background

A modified double-layered suturing procedure (origami method; OGM) can achieve robust closure, even for large mucosal defects, by folding the muscle layer using through-the-scope clips. This study aimed to evaluate the feasibility of OGM in duodenal endoscopic submucosal dissection (ESD).

Methods

This retrospective, observational study was conducted at a tertiary care hospital. We reviewed cases of OGM attempted after duodenal ESD between June 2022 and April 2023. We excluded lesions located in the duodenal bulb or involving the major papilla. We measured the clinical characteristics and outcomes.

Results

OGM was attempted in 28 cases after duodenal ESD. The median mucosal defect size was 38 mm (range 26−110). Complete closure was achieved in 27 cases (96%), including the largest lesion. The median closure time was 16 minutes. There were no perforations caused by clips. Delayed perforation and bleeding were not observed. Among 28 cases, 21 underwent follow-up endoscopy 3–5 days after ESD, and the muscle layer remained folded in all cases.

Conclusion

OGM achieved a high rate of complete closure even after duodenal ESD. Closure with OGM was robust enough to maintain the folded muscle layer for at least 3 days postoperatively.

Publication History

Received: 01 July 2024

Accepted after revision: 07 November 2024

Accepted Manuscript online:
07 November 2024

Article published online:
10 January 2025

• References

• 1 Kato M, Takeuchi Y, Hoteya S. et al. Outcomes of endoscopic resection for superficial duodenal tumors: 10 years’ experience in 18 Japanese high volume centers. Endoscopy 2022; 54: 663-670
• 2 Tsutsumi K, Kato M, Kakushima N. et al. Efficacy of endoscopic preventive procedures to reduce delayed adverse events after endoscopic resection of superficial nonampullary duodenal epithelial tumors: a meta-analysis of observational comparative trials. Gastrointest Endosc 2021; 93: 367-374.e363
• 3 Kato M, Ochiai Y, Fukuhara S. et al. Clinical impact of closure of the mucosal defect after duodenal endoscopic submucosal dissection. Gastrointest Endosc 2019; 89: 87-93
• 4 Inoue T, Uedo N, Yamashina T. et al. Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm. Dig Endosc 2014; 26: 220-227
• 5 Tanaka S, Toyonaga T, Obata D. et al. Endoscopic double-layered suturing: a novel technique for closure of large mucosal defects after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Endoscopy 2012; 44: E153-154
• 6 Masunaga T, Kato M, Sasaki M. et al. Modified double-layered suturing for a mucosal defect after colorectal endoscopic submucosal dissection (Origami method) (with video). Gastrointest Endosc 2023; 97: 962-969
• 7 Yahagi N, Nishizawa T, Akimoto T. et al. New endoscopic suturing method: string clip suturing method. Gastrointest Endosc 2016; 84: 1064-1065
• 8 Nishizawa T, Akimoto T, Uraoka T. et al. Endoscopic string clip suturing method: a prospective pilot study (with video). Gastrointest Endosc 2018; 87: 1074-1078
• 9 Dohi O, Yoshida N, Naito Y. et al. Efficacy and safety of endoscopic submucosal dissection using a scissors-type knife with prophylactic over-the-scope clip closure for superficial non-ampullary duodenal epithelial tumors. Dig Endosc 2020; 32: 904-913
• 10 Tashima T, Ohata K, Sakai E. et al. Efficacy of an over-the-scope clip for preventing adverse events after duodenal endoscopic submucosal dissection: a prospective interventional study. Endoscopy 2018; 50: 487-496
• 11 Ohata K, Sakai E, Suzuki Y. et al. Risk factors of delayed bleeding after endoscopic resection of superficial non-ampullary duodenal epithelial tumors and prevention by over-the-scope and conventional clipping. Dig Endosc 2021; 33: 390-398
• 12 Fukui H, Dohi O, Hirose T. et al. Clinical outcomes of the over-the-scope clip closure after duodenal endoscopic submucosal dissection: a multicenter retrospective study. J Gastroenterol Hepatol 2024; 39: 725-732
• 13 Irino T, Nunobe S, Hiki N. et al. Laparoscopic-endoscopic cooperative surgery for duodenal tumors: a unique procedure that helps ensure the safety of endoscopic submucosal dissection. Endoscopy 2015; 47: 349-351
• 14 Kanaji S, Morita Y, Yamazaki Y. et al. Feasibility of laparoscopic endoscopic cooperative surgery for non-ampullary superficial duodenal neoplasms: single-arm confirmatory trial. Dig Endosc 2021; 33: 373-380
• 15 Nunobe S, Ri M, Yamazaki K. et al. Safety and feasibility of laparoscopic and endoscopic cooperative surgery for duodenal neoplasm: a retrospective multicenter study. Endoscopy 2021; 53: 1065-1068
• 16 Hayashi H, Miyamoto H, Nakagawa S. et al. Distinct approaches (antecolic and retrocolic) according to tumor location in laparoscopic and endoscopic cooperative surgery for non-ampullary duodenum tumors. Surg Endosc 2023; 37: 6718-6726
• 17 Dohi O, Kato M, Takeuchi Y. et al. Clinical course and management of adverse events after endoscopic resection of superficial duodenal epithelial tumors: multicenter retrospective study. Dig Endosc 2023;