Incidence and risk factors for stricture after endoscopic submucosal dissection in the duodenal bulb

Endoscopic closure may prevent stricture after duodenal endoscopic submucosal dissection (ESD) beyond the superior duodenal angle. However, the incidence and risk factors for stricture after ESD in the duodenal bulb, which is difficult to close completely, remain unclear. This study aims to evaluate the incidence and risk factors for stricture after ESD in the duodenal bulb.

This retrospective observational study included lesions in the duodenal bulb treated by ESD at our institute between July 2010 and December 2023. We excluded cases in which confirmation of healing of the defect could not be completed endoscopically for any reason. We assessed the incidence and risk factors for stricture.

A total of 786 duodenal lesions were treated by ESD, of which 124 were located in the bulb. Finally, 101 cases were analyzed, with 82% left unclosed. Stricture occurred in 5 cases (5%). The median maximum diameter of mucosal defects was significantly greater in the stricture group (71 mm [range, 52-94] vs 37 mm [range, 10-120]; P = .0058). In addition, the circumferential extent of the defect was correlated with stricture risk (P < .0001), with stricture occurring in 63% of cases with circumferential involvement of seven-eighths or greater. Higher rates of resections over the pyloric ring and triamcinolone injections were noted in the stricture group (5 [100%] vs 40 [42%], P = .015; 5 [100%] vs 7 [8%], P < .0001).

Stricture developed in 5% of cases after ESD in the duodenal bulb and was associated with larger defects, pyloric resections, and triamcinolone injection.