对于胃上皮性肿瘤，二次内镜检查可能不会减少内镜黏膜下剥离术后的出血。
A second-look endoscopy may not reduce the bleeding after endoscopic submucosal dissection for gastric epithelial neoplasm.
作者信息
Takahashi Fumiaki, Yoshitake Naoto, Akima Takashi, Kino Hitoshi, Nakano Masakazu, Tsuchida Chieko, Tsuchida Kohei, Tominaga Keiichi, Sasai Takako, Masuyama Hironori, Hiraishi Hideyuki
机构信息
Department of Gastroenterology, Dokkyo Medical University, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan.
出版信息
BMC Gastroenterol. 2014 Aug 23;14:152. doi: 10.1186/1471-230X-14-152.
BACKGROUND
Gastric endoscopic submucosal dissection (ESD) has gradually come to be recommended as the optimal treatment for early gastric cancer; however, one of the primary issues is postoperative bleeding. Although second-look endoscopy is conventionally performed to reduce the risk of postoperative bleeding, its benefit has not yet been clearly elucidated. The objective of this study was to elucidate the benefit of second-look endoscopy.
METHODS
A total of 459 lesions in patients were underwent gastric ESD from May 2004 to April 2013 at our hospital were included in the analysis. The patients were divided into those who had bleeding within 24 hours after ESD (immediate bleeding) and those in whom bleeding occurred 24 hours or more after the procedure (delayed bleeding); the underlying disease, age, lesion site, diameter of the resected specimen, and lesion diameter were analyzed to identify the risk factors for postoperative bleeding after ESD.
RESULTS
Post-ESD immediate or delayed bleeding occurred in 23 of the 459 cases (5.0%). Second-look endoscopy was performed in 210 of 447 cases (47.0%) excluding 12 cases with immediate bleeding; in the remaining 237 of the 447 cases (53.0%), it was not performed. Post-ESD delayed bleeding occurred in 6 of the 210 cases (2.9%) and 5 of the 237 cases (2.1%), with no statistically significant difference between the two groups. Overall, the following factors were identified as the risk factors for postoperative bleeding: young age (P = 0.005), lesions in the L segment (P = 0.042), and large size of the resected specimen (P = 0.005). The risk factors identified in the immediate bleeding group were lesions in the L segment (P = 0.032), large size of the resected specimen (P < 0.001), and large tumor size (P = 0.011), and those in the delayed bleeding group were young age (P = 0.013) and concomitant renal disease (P = 0.011).
CONCLUSIONS
The results of this study suggest that second-look endoscopy after gastric ESD may not be useful for preventing postoperative bleeding.
背景
胃内镜黏膜下剥离术（ESD）已逐渐被推荐为早期胃癌的最佳治疗方法；然而，主要问题之一是术后出血。尽管传统上会进行二次内镜检查以降低术后出血风险，但其益处尚未得到明确阐明。本研究的目的是阐明二次内镜检查的益处。
方法
对2004年5月至2013年4月在我院接受胃ESD的患者中的459个病变进行分析。患者分为ESD后24小时内出血（即时出血）和术后24小时或更长时间出血（延迟出血）两组；分析基础疾病、年龄、病变部位、切除标本直径和病变直径，以确定ESD术后出血的危险因素。
结果
459例中有23例（5.0%）发生ESD术后即时或延迟出血。447例中，除12例即时出血患者外，210例（47.0%）进行了二次内镜检查；其余237例（53.0%）未进行。210例中有6例（2.9%）发生ESD术后延迟出血，237例中有5例（2.1%）发生，两组之间无统计学显著差异。总体而言，以下因素被确定为术后出血的危险因素：年轻（P = 0.005）、L段病变（P = 0.042）和切除标本尺寸大（P = 0.005）。即时出血组确定的危险因素为L段病变（P = 0.032）、切除标本尺寸大（P < 0.001）和肿瘤尺寸大（P = 0.011），延迟出血组的危险因素为年轻（P = 0.013）和合并肾病（P = 0.011）。
结论
本研究结果表明，胃ESD术后的二次内镜检查可能对预防术后出血无用。
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