Department of Digestive Endoscopy, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.
World J Gastroenterol. 2013 May 7;19(17):2704-8. doi: 10.3748/wjg.v19.i17.2704.
To evaluate the use of medical adhesive spray in endoscopic submucosal dissection (ESD).
Patients who underwent ESD between January 2009 and June 2012 (n = 173) were enrolled in the prospective randomized study. Two patients undergoing surgery due to severe intraoperative hemorrhage and failed hemostasis were excluded, and the remaining 171 patients were randomly divided into two groups: group A (medical adhesive group, n = 89) and group B (control group, n = 82). In group A, a medical adhesive spray was evenly applied after routine electrocoagulation and hemostasis using hemostatic clip after ESD. Patients in group B only treated with routine wound management. Intraoperative and postoperative data were collected and compared.
In all 171 patients, ESD was successfully completed. There was no significant difference in the average treatment time between groups A and B (59.4 min vs 55.0 min, respectively). The average length of hospital stay was significantly different between group A and B (8.89 d vs 9.90 d, respectively). The incidence of intraoperative perforation was 10.1% in group A and 9.8% in group B, and was not significantly different between the two groups. In all cases, perforations were successfully managed endoscopically and with conservative treatment. The incidence of postoperative delayed bleeding in group A was significantly lower than that in group B (0.00% vs 4.88%, respectively).
ESD is an effective minimally invasive treatment for gastrointestinal precancerous lesions or early-stage gastrointestinal cancer. Medical adhesive spray is effective in preventing delayed bleeding after ESD, and can thus reduce the average length of hospital stay.
评估医用胶喷涂在内镜黏膜下剥离术（ESD）中的应用。
2009 年 1 月至 2012 年 6 月期间接受 ESD 的患者（n=173）被纳入前瞻性随机研究。由于术中严重出血和止血夹止血失败而接受手术的 2 例患者被排除，其余 171 例患者被随机分为两组：A 组（医用胶组，n=89）和 B 组（对照组，n=82）。A 组患者在 ESD 后常规电凝和止血夹止血后均匀喷洒医用胶。B 组患者仅采用常规伤口管理。收集并比较两组患者的术中及术后数据。
所有 171 例患者均成功完成 ESD。A 组和 B 组的平均治疗时间分别为 59.4 分钟和 55.0 分钟，差异无统计学意义。A 组的平均住院时间明显短于 B 组（分别为 8.89 天和 9.90 天）。A 组术中穿孔发生率为 10.1%，B 组为 9.8%，两组间差异无统计学意义。所有穿孔均在内镜下成功处理，并采用保守治疗。A 组术后迟发性出血发生率明显低于 B 组（分别为 0.00%和 4.88%）。
ESD 是治疗胃肠道癌前病变或早期胃肠道癌的有效微创治疗方法。医用胶喷涂可有效预防 ESD 后迟发性出血，从而缩短平均住院时间。
