Criteria for the use of conventional clip and over-the-scope clip for closure of mucosal defects after duodenal endoscopic submucosal dissection

Abstract Purpose Over-the-scope clip (OTSC) is used for treatment of gastrointestinal perforation, postoperative anastomotic leakage, and for mucosal defect closure after duodenal endoscopic submucosal dissection (ESD). However, OTSCs are expensive and associated with fatal complications; therefore, proper OTSC usage is necessary. There are no clear criteria for OTSC use for mucosal defect closure after duodenal ESD. Therefore, we examined the closure outcomes achieved using OTSCs or conventional clips for patients that underwent duodenal ESD. We also analyzed the resected specimen area and preoperative estimated size of tumors treated with each method to determine the criteria for using either OTSC or conventional clip. Methods Endoscopic resection was performed for 133 superficial duodenal epithelial tumors at our institution from April 2017 to February 2022. Complete closure of mucosal defects after duodenal ESD was attempted for 82 tumors; these were divided into the OTSC group and the control group (for which conventional clips were used). Closure outcomes were analyzed. Results The overall rate of complete mucosal defect closure in the OTSC and control groups was 98.8% (95% confidence interval = 93.39–99.97%). There were significant differences in the median estimated tumor size (20 mm vs 15 mm; p < 0.001) and median resected specimen area (339.1 mm2 vs 169.6 mm2; p < 0.001) between the groups. Conclusion If the estimated preoperative tumor size is ≤ 18 mm, complete closure of mucosal defects after duodenal ESD can be achieved with only conventional clips. Based on this study, we suggest that OTSC is not necessary for small lesions.