Na Shin, Ahn Ji Yong, Choi Kee Don, Kim Mi-Young, Lee Jeong Hoon, Choi Kwi-Sook, Kim Do Hoon, Song Ho June, Lee Gin Hyug, Jung Hwoon-Yong, Kim Jin-Ho
Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea.
Dig Dis Sci. 2015 Oct;60(10):3108-17. doi: 10.1007/s10620-015-3693-x. Epub 2015 May 24.
Forrest classification is a valid tool to predict rebleeding rate in peptic ulcer, not in post-endoscopic resection ulcer. We evaluated the delayed bleeding rate in Forrest classification II and III lesions when they were not treated in second-look endoscopy.
Between July 2011 and February 2012, 706 lesions in 656 consecutive patients who underwent second-look endoscopy performed on the second day after endoscopic submucosal dissection (ESD) were prospectively investigated. Endoscopic findings were described according to Forrest classification, and late delayed bleeding was defined as bleeding from second-look endoscopy to 1 month. We evaluated the rate of late delayed bleeding in untreated Forrest classification II and III lesions during second-look endoscopy.
Among the 706 gastric tumors analyzed, late delayed bleeding after ESD occurred in 29 lesions (4.1%). At second-look endoscopy, Forrest I lesions (immediately treated by endoscopic hemostasis) were found in 63 cases [Ia, 8 lesions (1.1%); Ib, 55 lesions (7.8%)]; there was no further bleeding after discharge. Forrest II and III lesions (not treated in second-look endoscopy) were found in 643 cases [IIa, 62 lesions (8.8%); IIb, 119 lesions (16.9%); IIc, 460 lesions (65.2 %); III, 2 lesions (0.3%)]; and there was no significant difference in the late delayed bleeding rate between these groups [IIa, 2/62 (3.2%); IIb, 5/119 (4.2%); IIc and III, 22/462 (4.8%); P = 1.000].
The rate of late delayed bleeding of post-ESD ulcers with non-bleeding visible vessels was not significantly different from that of ulcers with non-visible vessels ( http://cris.nih.go.kr , identifier KCT0000268).
福里斯特分类法是预测消化性溃疡再出血率的有效工具，但不适用于内镜切除术后溃疡。我们评估了福里斯特分类II级和III级病变在未进行二次内镜检查时的延迟出血率。
2011年7月至2012年2月，对656例连续接受内镜黏膜下剥离术（ESD）后第二天进行二次内镜检查的患者中的706个病变进行了前瞻性研究。根据福里斯特分类法描述内镜检查结果，晚期延迟出血定义为从二次内镜检查至1个月内的出血。我们评估了二次内镜检查期间未治疗的福里斯特分类II级和III级病变的晚期延迟出血率。
在分析的706例胃肿瘤中，ESD后晚期延迟出血发生在29个病变中（4.1%）。在二次内镜检查时，发现63例福里斯特I级病变（立即接受内镜止血治疗）[Ia，8个病变（1.1%）；Ib，55个病变（7.8%）]；出院后无进一步出血。发现643例福里斯特II级和III级病变（未在二次内镜检查中治疗）[IIa，62个病变（8.8%）；IIb，119个病变（16.9%）；IIc，460个病变（65.2%）；III，2个病变（0.3%）]；这些组之间的晚期延迟出血率无显著差异[IIa，2/62（3.2%）；IIb，5/119（4.2%）；IIc和III，22/462（4.8%）；P = 1.000]。
ESD术后溃疡有不可见血管与有可见血管但未出血的晚期延迟出血率无显著差异（http://cris.nih.go.kr，标识符KCT0000268）。
