Lee Chang Kyun, Lee Suck-Ho, Park Ji-Young, Lee Tae Hoon, Chung Il-Kwun, Park Sang-Heum, Kim Hong-Soo, Kim Sun-Joo
Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea.
Gastrointest Endosc. 2009 Aug;70(2):353-61. doi: 10.1016/j.gie.2008.11.024. Epub 2009 Apr 21.
The most common complication of colonoscopic polypectomy is postpolypectomy bleeding (PPB). However, there are no established guidelines for the prevention of delayed PPB. It is possible that submucosal vessels of an artificial ulcer are a potential source of delayed bleeding that occurs several days after polypectomy.
The aim of this randomized, controlled study was to evaluate the efficacy of prophylactic argon plasma coagulation (APC) of nonbleeding visible vessels in preventing delayed PPB.
A prospective, randomized, controlled study.
A tertiary referral center.
A total of 987 polyps in 600 consecutive patients were resected by colonoscopic polypectomy.
In patients who underwent APC (APC group), all nonbleeding visible vessels on the ulcer crater were targeted and were then coagulated by APC ablation until they disappeared, but not in patients who did not undergo APC (control group).
The incidence of delayed PPB in the APC group was compared with that in the control group.
Delayed PPB occurred in 3.3% (16/475) of all the patients, including 2.5% (6/240) in the APC group and 4.3% (10/235) in the control group. No significant differences were observed between the 2 groups in the rates of delayed PPB, irrespective of the type of delayed bleeding (significant bleeding: 0.8% [2/240] vs 1.3% [3/235], P = .638; minor bleeding: 1.7% [4/240] vs 3% [7/235], P = .378). There were no significant APC-related complications.
Single-center study.
Prophylactic APC ablation does not appear to have an additional advantage in the prevention of delayed PPB.
结肠镜息肉切除术后最常见的并发症是息肉切除术后出血（PPB）。然而，目前尚无预防延迟性PPB的既定指南。人工溃疡的黏膜下血管可能是息肉切除术后数天发生延迟出血的潜在来源。
本随机对照研究旨在评估对无出血可见血管进行预防性氩离子凝固术（APC）预防延迟性PPB的疗效。
一项前瞻性、随机、对照研究。
一家三级转诊中心。
连续600例患者共987个息肉接受了结肠镜息肉切除术。
接受APC治疗的患者（APC组），对溃疡灶上所有无出血可见血管进行靶向处理，然后通过APC消融使其凝固直至消失；未接受APC治疗的患者（对照组）则不进行此操作。
比较APC组和对照组延迟性PPB的发生率。
所有患者中延迟性PPB的发生率为3.3%（16/475），其中APC组为2.5%（6/240），对照组为4.3%（10/235）。两组在延迟性PPB发生率方面未观察到显著差异，无论延迟出血的类型如何（严重出血：0.8%[2/240]对1.3%[3/235]，P = 0.638；轻微出血：1.7%[4/240]对3%[7/235]，P = 0.378）。未发生与APC相关的显著并发症。
单中心研究。
预防性APC消融在预防延迟性PPB方面似乎没有额外优势。
