title: Safety of endoscopic resection for duodenal subepithelial lesions with wound closure using clips and an endoloop: an analysis of 68 cases.
abstract: Endoscopic removal of a duodenal lesion is still considered to be a challenging procedure that can be fraught with potentially serious complications, specifically perforation or delayed bleeding. This study was to assess the safety of endoscopic resection for duodenal subepithelial lesions (SELs) with wound closure using clips and an endoloop.
  
  
  
  From October 2010 to July 2015, a total of 68 consecutive patients with duodenal SELs were treated with endoscopic resection with wound closure using clips and an endoloop. The main outcome measures considered were the incidence of complete resection, perioperative perforation, delayed perforation, delayed bleeding, residual lesions, and lesion recurrence.
  
  
  
  Complete resection was successfully achieved for all 68 patients. The median lesion size was 1.7 cm. The median procedure time was 62 min. The mean hospital stay was 5.5 days. During the procedure, five patients developed perioperative perforations (7.4 %) and no patients developed delayed bleeding, delayed perforation, or other serious complications. The five patients with perioperative perforations recovered after conservative treatment. The perioperative perforation rate was significantly higher for lesions originating in the muscularis propria layer (18.2 %) than in the submucosal layer (2.2 %; p < 0.05). No residual or recurrent lesions were detected during the follow-up period (median: 27 months).
  
  
  
  Endoscopic resection with wound closure using clips and an endoloop is an effective and reasonably safe therapeutic method for treating/removing duodenal SELs when managed by an experienced endoscopic team, and it can provide an alternative treatment option for patients with duodenal SELs.
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Ye
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China.
authors.forename: Xin-Li
authors.initials: XL
authors.lastname: Mao
authors.affiliation: Department of Pathology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, Zhejiang Province, China.
authors.forename: Hai-Hong
authors.initials: HH
authors.lastname: Zheng
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China. zhangyu783@126.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China.
authors.forename: Ling-Yan
authors.initials: LY
authors.lastname: Shen
authors.affiliation: Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, 150 Ximen Street, Linhai, 317000, Zhejiang Province, China.
authors.forename: Xian-Bin
authors.initials: XB
authors.lastname: Zhou
authors.affiliation: Department of Medical Administration, Taizhou Hospital of Zhejiang Province, Wenzhou Medical College, Linhai, China.
authors.forename: Lin-Hong
authors.initials: LH
authors.lastname: Zhu
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D002828:Choristoma / Q000601:surgery; D004378:Duodenal Diseases / Q000601:surgery; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D004384:Duodenoscopy; D004386:Duodenum / Q000473:pathology / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology / Q000601:surgery*; D006222:Hamartoma / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D008067:Lipoma / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D010179:Pancreas; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012449:Safety; D013525:Surgical Instruments; D016896:Treatment Outcome; D058106:Wound Closure Techniques / Q000295:instrumentation*
keywords: Clip; Duodenal subepithelial lesion; Endoloop; Endoscopic resection; Wound closure