Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration.

Abstract

AIM:

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.

CONCLUSION:

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: Hirohito Mori, Maki Ayaki, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Tatsuo Yachida, Tsutomu Masaki
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 21 Issue 17 Pg. 5281-6 (May 07 2015) ISSN: 2219-2840 [Electronic] United States
• PMID: 25954101 (Publication Type: Comparative Study, Journal Article, Multicenter Study)

Topics

• Adenocarcinoma (pathology, surgery)
• Adenoma (pathology, surgery)
• Aged
• Cost-Benefit Analysis
• Duodenal Neoplasms (pathology, surgery)
• Duodenoscopy (adverse effects, economics)
• Duodenum (pathology, surgery)
• Female
• Health Care Costs
• Humans
• Japan
• Leiomyoma (pathology, surgery)
• Male
• Middle Aged
• Operative Time
• Retrospective Studies
• Surgical Instruments (economics)
• Time Factors
• Treatment Outcome
• Wound Closure Techniques (adverse effects, economics, instrumentation)