Origami method for duodenal ESD

The Origami Method (OGM) is a modified double-layered suturing technique developed specifically for closing large mucosal defects following duodenal endoscopic submucosal dissection (ESD). Duodenal ESD is a minimally invasive procedure used to remove lesions or tumors from the duodenum but often results in sizeable defects. These defects pose significant risks, including perforation and bleeding, making effective closure techniques critical.

### Key Features of the Origami Method:

1. **Double-Layered Closure**:

• The technique involves folding the muscle layer inward and securing it with through-the-scope clips. This creates a double-layered closure that enhances stability and promotes better healing of the defect.

2. **Improved Stability**:

• The inward folding of the muscle layer ensures that the closure is robust and durable, minimizing the risk of postoperative complications.

3. **Efficient Procedure**:

• The median closure time for OGM is reported to be only 16 minutes, demonstrating its practicality and efficiency in clinical settings.

4. **Safety and Durability**:

• In a study of 28 patients, OGM achieved complete closure in 96% of cases (27 out of 28), including the largest lesion with a defect size of 110 mm.
• Follow-up endoscopy conducted in 21 patients within 3–5 days post-procedure confirmed that the folded muscle layer remained intact in all cases.
• No complications related to clipping were observed, including zero cases of clip-induced perforations, delayed perforations, or delayed bleeding.

### Study Details:

• **Patient Pool**:
• The study included 28 patients treated between June 2022 and April 2023 at a tertiary hospital.
• Lesions in the duodenal bulb or involving the major papilla were excluded from the analysis.
• **Defect Size**:
• The median defect size was 38 mm, ranging from 26 to 110 mm, indicating the method's capability to handle large defects effectively.

### Advantages of the Origami Method:

1. **High Success Rate**:

• Achieved a near-perfect closure rate of 96%.

2. **Safety**:

• No complications related to the closure technique were reported.

3. **Durability**:

• The folded muscle layer remained intact during follow-up, demonstrating reliable postoperative healing.

4. **Efficiency**:

• The median closure time was relatively short, at 16 minutes.

### Clinical Implications:

The Origami Method offers a promising alternative to conventional closure techniques for managing large duodenal defects caused by ESD. Its ability to provide reliable, safe, and durable closures makes it highly feasible for clinical use, especially in challenging cases involving large mucosal defects.

In summary, OGM represents a significant advancement in duodenal ESD defect management, combining practicality, safety, and effectiveness to reduce postoperative risks and improve patient outcomes.