Related Experiment Video
Updated: Oct 2, 2026
Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
Published on: April 28, 2026
Short-term outcomes of a refined duodenal LECS technique: A single-center retrospective series
Hiroki Harada1, Mikiko Sakuraya1, Takuya Wada2
1Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0373, Japan.
Background:
Duodenal laparoscopic and endoscopic cooperative surgery (D-LECS) is an alternative to endoscopic submucosal dissection (ESD) for duodenal tumors, but technical instability and adverse events remain concerns. We aimed to describe the short-term outcomes of refined D-LECS and temporal changes in horizontal margin status and operative time.
Methods:
This retrospective single-center study included 40 patients who underwent D-LECS between August 2021 and February 2026. Refinements included complete Kocher mobilization to straighten the duodenum and stabilize ESD, use of a Clutch Cutter under the water pressure method for safe dissection and hemostasis, duodenal re-fixation to restore physiological orientation, full-thickness horizontal mattress suturing for secure defect closure, and selective use of the reopenable clip-over-the-line method for defects at the pancreatic attachment. The primary endpoint was delayed perforation; secondary endpoints included postoperative outcomes, pathological margin status, R0 resection, and operative time.
Results:
En bloc resection was achieved in all cases. Nine patients (22.5%) experienced Clavien-Dindo Grade II complications, and two patients (5.0%) experienced Grade III complications, including one delayed perforation and one wound infection requiring drainage. No patient required reoperation, and DGE occurred in one patient (2.5%). Median postoperative hospital stay was 8 days. HM1/HMX was observed in 5 lesions, while VMX was observed in 1 lesion and no lesion was VM1. The pathological R0 resection rate was 87.5% (35/40). HM1/HMX was observed in 4 of 12 patients (33.3%) in the early phase and 1 of 28 patients (3.6%) in the late phase. Mean operation time decreased from 323 min in the early phase to 270 min in the late phase (p = 0.048).
Conclusions:
Refined D-LECS was associated with acceptable short-term outcomes in this single-center retrospective series. HM1/HMX was less frequent and operation time was shorter in the later phase, although these temporal changes cannot be attributed to individual technical refinements.
