Background: Modified double-layered suturing (Origami method; OGM), which can achieve robust closure even for large mucosal defects by folding the muscle layer using only through-the-scope clips. This study aimed to evaluate the feasibility of this OGM in duodenal ESD.
Methods: This retrospective observational study was conducted at a tertiary care hospital. We reviewed the cases of OGM attempted after duodenal ESD between June 2022 and April 2023. We excluded lesions located in bulbs and involving major papilla. We measured the clinical characteristics and outcomes.
Results: The OGM was attempted in 28 cases after duodenal ESD. The median mucosa defect size was 38 mm [range, 26-110]. Complete closure was achieved in 27 cases (96%), including the largest lesion. The median closure time was 16 min. There were no perforations caused by clips. Delayed perforation and bleeding were not observed. Among of 28 cases, 21 cases underwent the follow-up endoscopy 3-5 days after ESD, in which a folded muscle layer was kept in all cases.
Conclusion: The OGM achieved high-rate complete closure even after duodenal ESD, which was robust enough to maintain the folded muscle layer for at least 3 days postoperatively.
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