Kim Jae Woo, Kim Hyun Soo, Park Dong Hoon, Park Yong Soon, Jee Myeong Gwan, Baik Soon Koo, Kwon Sang Ok, Lee Dong Ki
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Eur J Gastroenterol Hepatol. 2007 May;19(5):409-15. doi: 10.1097/MEG.0b013e32801015be.
Although endoscopic mucosal resection has been recognized as the standard treatment for gastric mucosal neoplasm, postendoscopic mucosal resection hemorrhage remains a major complication of endoscopic mucosal resection, and this problem seems to be increasing owing to the development of invasive techniques. The aims of this study were to determine the incidence and grade of postendoscopic mucosal resection hemorrhage and to identify risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric neoplasm.
Data of endoscopic mucosal resections performed by three endoscopists were retrospectively collected over 8 years and then analyzed. Immediate postendoscopic mucosal resection hemorrhage was defined as bleeding during the procedure. Delayed postendoscopic mucosal resection hemorrhage was defined when two of the four following parameters were satisfied after the endoscopic mucosal resection period; (i) hematemesis, melena or dizziness, (ii) hemoglobin loss >2 g/dl, (iii) blood pressure decrease >20 mmHg or pulse rate increase >20/min and (iv) Forrest I or IIa-IIb on follow-up endoscopy.
A total of 157 patients (mean age: 64 years, male : female=44 : 113) were reviewed. Twenty-nine (18.5%) and 13 patients (8.3%) presented with immediate and delayed postendoscopic mucosal resection hemorrhage, respectively. Multivariate logistic regression analysis revealed that the patient's age (<or=65 years; odds ratio 6.11, 95% confidence interval 1.12-33.43), the size of lesion (>15 mm; odds ratio 5.90, 95% confidence interval 1.13-30.87) and the experience of the endoscopist (<or=5 years; odds ratio 16.31, 95% confidence interval 1.46-181.97) were significantly predictive variables for the delayed postendoscopic mucosal resection hemorrhage.
Considering the higher risk of delayed postendoscopic mucosal resection hemorrhage, careful preparation and close monitoring are required for patients who are less than 65 years, have large lesions over 15 mm or if the procedures were performed by an inexperienced endoscopist.
尽管内镜下黏膜切除术已被公认为胃黏膜肿瘤的标准治疗方法，但内镜下黏膜切除术后出血仍是内镜下黏膜切除术的主要并发症，并且由于侵入性技术的发展，这个问题似乎在增加。本研究的目的是确定胃肿瘤患者内镜下黏膜切除术后出血的发生率和分级，并识别内镜下黏膜切除术后延迟出血的危险因素。
回顾性收集三位内镜医师在8年期间进行的内镜下黏膜切除术的数据，然后进行分析。内镜下黏膜切除术后即刻出血定义为手术过程中出血。内镜下黏膜切除术后延迟出血定义为在内镜下黏膜切除术后期间满足以下四个参数中的两个时；（i）呕血、黑便或头晕，（ii）血红蛋白下降>2 g/dl，（iii）血压下降>20 mmHg或脉搏率增加>20/分钟，以及（iv）随访内镜检查时为福里斯特I级或IIa-IIb级。
共纳入157例患者（平均年龄：64岁，男性：女性 = 44：113）。分别有29例（18.5%）和13例（8.3%）出现内镜下黏膜切除术后即刻出血和延迟出血。多因素逻辑回归分析显示，患者年龄（≤65岁；比值比6.11，95%置信区间1.12 - 33.43）、病变大小（>15 mm；比值比5.90，95%置信区间1.13 - 30.87）和内镜医师经验（≤5年；比值比16.31，95%置信区间1.46 - 181.97）是内镜下黏膜切除术后延迟出血的显著预测变量。
考虑到内镜下黏膜切除术后延迟出血的风险较高，对于年龄小于65岁、有大于15 mm的大病变或由经验不足的内镜医师进行手术的患者，需要仔细准备和密切监测。
