Department of Gastroenterology, Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012, Japan.
Surg Endosc. 2018 Aug;32(8):3622-3629. doi: 10.1007/s00464-018-6091-6. Epub 2018 Feb 7.
Advances in Endoscopic submucosal dissection (ESD) technology have established ESD for early gastric cancer as a safe and stable technique. However, ESD may induce delayed gastric emptying and the cause of food residue retention in the stomach after ESD is not clear. This study aimed to clarify risk factors for delayed gastric emptying with food retention after gastric ESD.
We retrospectively examined for food residue in the stomach 1 week after ESD was performed for early gastric carcinoma at Osaka Saiseikai Nakatsu Hospital from February 2008 to November 2016.
Food residue was observed in 68 (6.1%) of 1114 patients who underwent gastric ESD. The percentage of lesions located on the lesser curvature of the upper third of the stomach was 45.6% (31/68) in the food residue group and 3.5% (37/1046) in the non-food residue group, which was significantly different (P < 0.01). Multivariate logistic regression analysis revealed that lesions on the lesser curvature of the upper third of the stomach (Odds ratio [OR] 23.31, 95% confidence interval [CI] 12.60-43.61, P < 0.01), post-ESD bleeding (OR 4.25, 95%CI 1.67-9.80, P < 0.01), submucosal invasion (OR 2.80, 95%CI 1.34-5.63, P < 0.01), and age over 80 years (OR 2.34, 95%CI 1.28-4.22, P < 0.01) were independent risk factors for food retention after gastric ESD. Of the 68 patients, 3 had food residue in the stomach on endoscopic examination for follow-up observation after the ESD ulcer had healed.
Delayed gastric emptying with food retention after gastric ESD was associated with lesions located in the lesser curvature of the upper stomach, submucosal invasion of the lesion, age older than 80 years, and post-ESD bleeding, though it was temporary in most cases.
内镜黏膜下剥离术（ESD）技术的进步已经确立了 ESD 治疗早期胃癌的安全性和稳定性。然而，ESD 可能会导致胃排空延迟，并且 ESD 后食物残留在胃中的原因尚不清楚。本研究旨在阐明胃 ESD 后发生胃排空延迟伴食物残留的危险因素。
我们回顾性分析了 2008 年 2 月至 2016 年 11 月期间在大阪市税込会中津医院因早期胃癌行胃 ESD 治疗后 1 周时胃内食物残留的情况。
在 1114 例行胃 ESD 的患者中，有 68 例（6.1%）观察到胃内有食物残留。在有食物残留的 68 例患者中，病变位于胃上 3 分之 1 小弯侧的比例为 45.6%（31/68），而在无食物残留的 1046 例患者中，这一比例为 3.5%（37/1046），差异有统计学意义（P<0.01）。多变量 logistic 回归分析显示，胃上 3 分之 1 小弯侧的病变（优势比 [OR] 23.31，95%置信区间 [CI] 12.60-43.61，P<0.01）、ESD 后出血（OR 4.25，95%CI 1.67-9.80，P<0.01）、黏膜下浸润（OR 2.80，95%CI 1.34-5.63，P<0.01）和年龄大于 80 岁（OR 2.34，95%CI 1.28-4.22，P<0.01）是胃 ESD 后发生食物残留的独立危险因素。在 68 例患者中，有 3 例在 ESD 溃疡愈合后的内镜随访观察时发现胃内有食物残留。
胃 ESD 后胃排空延迟伴食物残留与胃上 3 分之 1 小弯侧的病变、病变的黏膜下浸润、年龄大于 80 岁和 ESD 后出血有关，但在大多数情况下是暂时的。
