Choi Kee Don, Jung Hwoon-Yong, Lee Gin Hyug, Oh Tae Hoon, Jo Ji Yun, Song Ho June, Hong Seoung Soo, Kim Jin-Ho
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea.
Surg Endosc. 2008 Aug;22(8):1882-6. doi: 10.1007/s00464-008-9743-0. Epub 2008 Feb 13.
Bleeding is a major complication of endoscopic mucosal resection (EMR). This study investigated whether the use of metal hemoclips to close EMR-induced ulcers after gastric EMR was effective in preventing delayed bleeding.
This single-center study retrospectively examined the records for 150 lesions of 140 consecutive patients (107 men and 33 women) with a mean age of 61 years (range, 38-81 years) who underwent EMR. For 60 patients, moderate to severe immediate bleeding occurred during the procedure, and the ulcers had been closed using metal hemoclips (clip group). In the remaining 90 cases, the immediate bleeding was absent or mild, and hemoclips were not used (nonclip group). Postprocedure bleeding (delayed bleeding) was analyzed.
Overall, delayed bleeding occurred with 14 (9.3%) of the 150 lesions. Delayed bleeding occurred less frequently in the clip group (2 of 60 lesions; 3.3%) than in the nonclip group (12 of 90 lesions; 13.3%; p = 0.04). Of the 60 clip group ulcers, 37 (62%) were completely closed, and none showed delayed bleeding. The median number of hemoclips used for ulcer closure was 10 (range, 4-22), and the median time for ulcer closure was 14 min (range, 4-40 min).
Prophylactic closure of gastric EMR-induced ulcers with hemoclips reduced delayed bleeding.
出血是内镜黏膜切除术（EMR）的主要并发症。本研究调查了在胃EMR术后使用金属止血夹闭合EMR引起的溃疡是否能有效预防延迟性出血。
本单中心研究回顾性分析了140例连续患者（107例男性和33例女性）的150个病变记录，这些患者平均年龄61岁（范围38 - 81岁），均接受了EMR。60例患者在手术过程中发生中度至重度即时出血，其溃疡已使用金属止血夹闭合（止血夹组）。其余90例患者即时出血不存在或轻微，未使用止血夹（非止血夹组）。对术后出血（延迟性出血）进行分析。
总体而言，150个病变中有14个（9.3%）发生延迟性出血。止血夹组延迟性出血的发生率（60个病变中有2个；3.3%）低于非止血夹组（90个病变中有12个；13.3%；p = 0.04）。在60个止血夹组溃疡中，37个（62%）完全闭合，均未出现延迟性出血。用于溃疡闭合的止血夹中位数为10个（范围4 - 22个），溃疡闭合的中位时间为14分钟（范围4 - 40分钟）。
用止血夹预防性闭合胃EMR引起的溃疡可减少延迟性出血。
