Ogiyama Hideharu, Tsutsui Shusaku, Murayama Yoko, Maeda Shingo, Satake Shin, Nasu Ayaka, Umeda Daisuke, Miura Yoshio, Tominaga Kouhei, Horiki Masashi, Sanomura Tamana, Imanaka Kazuho, Iishi Hiroyasu
Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan.
Endosc Int Open. 2018 May;6(5):E582-E588. doi: 10.1055/a-0581-8886. Epub 2018 May 8.
Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large superficial colorectal tumors, but delayed bleeding remains one of the most common complications of colorectal ESD. The aim of the present study was to evaluate the clinical efficacy of prophylactic clip closure of mucosal defects for the prevention of delayed bleeding after colorectal ESD.
We enrolled consecutive patients with colorectal lesions between January 2012 and May 2017 in this retrospective study. In the early part of this period, post-ESD mucosal defects were not closed (non-closure group); however, from January 2014, post-ESD mucosal defects were prophylactically closed with clips when possible (closure group). The main outcome measured was delayed bleeding. Variables were analyzed using the chi-squared test, Fisher's exact test, or Student's t-test.
Of 156 lesions analyzed, 61 were in the non-closure group and 95 in the closure group. Overall, delayed bleeding occurred in 5 cases (3.2 %). The delayed bleeding rate was 0 % (0/95) in the closure group and 8.2 % (5/61) in the non-closure group ( = 0.008). The mean procedure time for closure was 10.4 ± 4.6 min (range 3 - 26 min).
We demonstrated that prophylactic clip closure of mucosal defects might reduce the risk of delayed bleeding after colorectal ESD.
内镜黏膜下剥离术（ESD）整块切除率高，广泛应用于治疗大型浅表性结直肠肿瘤，但延迟出血仍是结直肠ESD最常见的并发症之一。本研究旨在评估预防性夹闭黏膜缺损对预防结直肠ESD术后延迟出血的临床疗效。
在这项回顾性研究中，我们纳入了2012年1月至2017年5月期间连续的结直肠病变患者。在这段时间的早期，ESD术后的黏膜缺损未进行闭合（非闭合组）；然而，从2014年1月起，ESD术后的黏膜缺损尽可能采用夹子进行预防性闭合（闭合组）。主要观察指标为延迟出血。采用卡方检验、Fisher精确检验或学生t检验对变量进行分析。
在分析的156个病变中，非闭合组61个，闭合组95个。总体而言，5例（3.2%）发生延迟出血。闭合组延迟出血率为0%（0/95），非闭合组为8.2%（5/61）（P = 0.008）。闭合的平均操作时间为10.4 ± 4.6分钟（范围3 - 26分钟）。
我们证明，预防性夹闭黏膜缺损可能降低结直肠ESD术后延迟出血的风险。
