| Theme |
Diagnosis and Treatment of Non-ampullary Duodenal Epithelial Tumor -- Current Status and Issues |
| Title |
Prevention of Postoperative Complications of Duodenal Endoscopic Resection -- Use of Pancreatic Drainage and Tissue Shielding Using Polyglycolic Acid Sheets |
| Author |
Kengo Takimoto |
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center |
| Author |
Naoki Esaka |
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center |
| Author |
Bunji Endoh |
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center |
| Author |
Yoshinori Mizumoto |
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center |
| Author |
Shinji Katsushima |
Department of Gastroenterology, National Hospital Organization Kyoto Medical Center |
| Author |
Dai Tamaki |
Department of Gastroenterology, Takeda General Hospital |
| [ Summary ] |
The rate of postoperative duodenal perforation following endoscopic submucosal dissection (ESD) is higher than that observed in other gastrointestinal organs owing to exposure of the ulcer floor to pancreatic juice and bile. Conceivable methods of prevention of perforation are protecting the ulcer floor via suturing or sheeting, or external drainage of the pancreatic juice and bile. Complete suturing of the ulcer by clipping is useful, although this is difficult in cases with a large-sized ulcer observed after ESD. We have been using an endoscopic tissue shielding method in which polyglycolic acid absorbable sheets (which have long been used in the surgical field), are spread over the entire ulcer floor and fixed using fibrin glue. In our view, it is more important to prevent exposure to pancreatic juice than to bile because the stronger enzymes in the pancreatic juice may cause greater tissue destruction. We have been utilizing endoscopic nasopancreatic drainage to prevent postoperative perforation. This article describes the usefulness of these methods and the difficulties that require resolution. |