title: Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration.
abstract: OBJECTIVE
  To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures.
  
  
  METHODS
  Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed.
  
  
  RESULTS
  Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs.
  
  
  CONCLUSIONS
  If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs.
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yachida
authors.affiliation: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003362:Cost-Benefit Analysis; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy / Q000009:adverse effects / Q000191:economics*; D004386:Duodenum / Q000473:pathology / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007564:Japan; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation
keywords: Bile acid; Closure time; Endoscopic resection; Over-the-scope clip; Pancreatic juice