Tan Eng Soon, Wang Hua, Lua Guan Way, Liu Feng, Shi Xin Gang, Li Zhao Shen
Department of Gastroenterology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
Dig Surg. 2016;33(6):455-61. doi: 10.1159/000446252. Epub 2016 May 26.
This study was conducted to evaluate the effectiveness of fibrin glue (FG) in preventing delayed bleeding after gastric endoscopic submucosal dissection (ESD).
From 2011 to 2014, 423 patients undergoing gastric ESDs were studied retrospectively. After excluding 26 patients, 397 were enrolled. The post-ESD wounds were treated with only coagrasper/clips before April 2013. After that, additional FG spray was utilized for wound closure. The post-ESD bleeding rates were compared between the FG group (patients with postoperative use of FG) and the non-FG group (patients without the use of FG).
A total of 397 lesions were successfully resected from 397 patients. The FG group significantly had more risk factors predisposing to delayed bleeding, such as advanced age, larger specimen size, more cancerous lesions and longer operation time. There was no significant difference in gender, comorbidity, lesion locations, numbers of coagrasper and hemoclips used between the 2 groups. The total rate of delayed bleeding was 4.53% (18/397). There were 18 cases of delayed bleeding (5.98%) in the non-FG group and none in the FG group (p = 0.03). Univariate analysis showed that FG reduced the risk of delayed bleeding significantly (p = 0.03).
FG was simple and effective in preventing delayed bleeding after gastric ESDs.
本研究旨在评估纤维蛋白胶（FG）在预防胃内镜黏膜下剥离术（ESD）后延迟出血方面的有效性。
回顾性研究2011年至2014年期间接受胃ESD的423例患者。排除26例患者后，纳入397例。2013年4月前，ESD术后创面仅用凝切器/夹子处理。此后，额外使用FG喷雾进行创面封闭。比较FG组（术后使用FG的患者）和非FG组（未使用FG的患者）的ESD术后出血率。
共从397例患者成功切除397个病变。FG组有更多易导致延迟出血的危险因素，如高龄、标本尺寸更大、癌性病变更多及手术时间更长。两组在性别、合并症、病变位置、使用的凝切器和止血夹数量方面无显著差异。延迟出血总发生率为4.53%（18/397）。非FG组有18例延迟出血（5.98%），FG组无延迟出血（p = 0.03）。单因素分析显示FG显著降低了延迟出血风险（p = 0.03）。
FG在预防胃ESD术后延迟出血方面简单有效。
