title: Management of a large mucosal defect after duodenal endoscopic resection.
abstract: Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Fujihara
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Mori
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobara
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishiyama
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ayaki
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yachida
authors.affiliation: Shintaro Fujihara, Hirohito Mori, Hideki Kobara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa University Faculty of Medicine, Kagawa 761-0793, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Masaki
mesh_terms: D004379:Duodenal Neoplasms / Q000601:surgery; D004386:Duodenum / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology; D010535:Laparoscopy; D013536:Suture Techniques / Q000295:instrumentation
keywords: Bleeding; Clip; Closure; Complication; Duodenum; Endoscopic full-thickness resection; Endoscopic mucosal resection; Endoscopic submucosal dissection; Over-the-scope clip; Perforation