Predictors of technical difficulty for complete closure of mucosal defects after duodenal endoscopic resection
Predictors of technical difficulty for complete closure of mucosal defects after duodenal endoscopic resection
复制标题
DOI：
10.1016/j.gie.2021.04.017
复制
发表时间：
2021-09-14
影响因子：
7.7
通讯作者：
Yahagi, Naohisa
中科院分区：
文献类型：
--
作者：
Mizutani, Mari;Kato, Motohiko;Yahagi, Naohisa
背景和目标：据报道，十二指肠内镜切除术（ER）后预防性关闭粘膜缺损可减少迟发性不良事件;然而，在某些情况下，这可能具有技术挑战性。因此，本研究的目的是确定在十二指肠ER.Methods后粘膜缺损完全关闭困难的预测因素：这是一项回顾性研究，在2010年7月至2020年5月之间进行ER的十二指肠病变。我们回顾了内镜图像，并使用单变量和多变量analysis.Results：我们分析了698个病变的闭合程度或闭合时间和病变的临床特征之间的关系。多变量分析显示，病变位于内侧壁或前壁（比值比，2.8; 95%置信区间，1.36-5.85; P <0.01）和病变尺寸较大（比值比，1.4; 95%置信区间，1.07-1.89; P = 0.03）是不完全闭合风险增加的独立预测因素。此外，大的病变尺寸（β系数，.304; P < .01），占用周长超过50%（B系数，.178; P < .01），术中穿孔（β系数，0.175; P <0.01），治疗期（β系数，0.143; P <0.01），和内镜粘膜下剥离术治疗（β系数，0.125; P <0.01）在多元回归分析中与闭合时间延长独立正相关。本研究表明，病变部位在内侧或前壁和病变大小影响十二指肠ER后粘膜缺损的不完全闭合，病变大小、占用周长、术中穿孔、治疗时间和治疗方法影响闭合时间。
Background and Aims: It has been reported that the prophylactic closure of mucosal defects after duodenal endoscopic resection (ER) can reduce delayed adverse events; however, under certain circumstances, this can be technically challenging. Therefore, the aim of this study was to determine the predictors of difficulty during the complete closure of mucosal defects after duodenal ER.Methods: This was a retrospective study of duodenal lesions that underwent ER between July 2010 and May 2020. We reviewed the endoscopic images and analyzed the relationships between the degree of closure or closure time and clinical features of the lesions using univariate and multivariate analyses.Results: We analyzed 698 lesions. The multivariate analysis revealed that lesion location in the medial or anterior wall (odds ratio, 2.8; 95% confidence interval, 1.36-5.85; P < .01) and a large lesion size (odds ratio, 1.4; 95% confidence interval, 1.07-1.89; P = .03) were independent predictors of an increased risk of incomplete closure. Moreover, a large lesion size (beta coefficient, .304; P < .01), an occupied circumference over 50% (b coefficient,.178; P < .01), intraoperative perforation (beta coefficient, .175; P < .01), treatment period (beta coefficient, .143; P < .01), and treatment with endoscopic submucosal dissection (beta coefficient, .125; P < .01) were independently and positively correlated with a prolonged closure time in the multiple regression analysis.Conclusions: This study revealed that lesion location in the medial or anterior wall and lesion size affected the incomplete closure of mucosal defects after duodenal ER, and lesion size, occupied circumference, intraoperative perforation, treatment period, and treatment method affected closure time.