Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, 2-297-1, Chiaki, Nagaoka, Niigata, 940-2085, Japan.
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Gastric Cancer. 2019 May;22(3):567-575. doi: 10.1007/s10120-018-0878-y. Epub 2018 Sep 28.
Delayed bleeding is an important complication after gastric endoscopic submucosal dissection (ESD). The search, coagulation, and clipping (SCC) method can be used to prevent delayed bleeding after ESD. However, its safety and efficacy are unclear. We compared the SCC method with post-ESD coagulation (PEC) to clarify the safety and efficacy of the SCC method for preventing delayed bleeding after gastric ESD.
This retrospective study included 438 patients (478 lesions) who underwent gastric ESD. Multivariate logistic regression analysis was performed to identify the significant independent factors associated with delayed bleeding and we performed propensity-score matching (PSM) to reduce the effect of procedure-selection bias of SCC method.
Of the 438 patients, 216 underwent PEC and 222 underwent SCC. Delayed bleeding was significantly less common in the SCC than in the PEC (2.6% vs. 7.2%; P = 0.013). Among patients treated with antithrombotic therapy, the delayed bleeding rate was lower in the SCC group than in the PEC group; however, the difference was not significant (P = 0.15). The SCC method was found to be a significant independent factor for the prevention of delayed bleeding. PSM was performed in 156 patients in the PEC group and SCC group. There was a significant difference in the incidence of bleeding in the PEC and SCC groups (P = 0.013). No patient had perforation/bleeding associated with the SCC method.
Our findings suggest that the SCC method is a simple, safe, and effective approach for preventing delayed bleeding after gastric ESD.
延迟性出血是胃内镜黏膜下剥离术（ESD）后的一个重要并发症。搜索、凝血和夹闭（SCC）方法可用于预防 ESD 后延迟性出血。然而，其安全性和有效性尚不清楚。我们比较了 SCC 方法与 ESD 后凝血（PEC），以阐明 SCC 方法预防胃 ESD 后延迟性出血的安全性和有效性。
本回顾性研究纳入了 438 例（478 处病变）接受胃 ESD 的患者。采用多变量逻辑回归分析确定与延迟性出血相关的显著独立因素，并进行倾向评分匹配（PSM）以减少 SCC 方法选择偏倚的影响。
438 例患者中，216 例行 PEC，222 例行 SCC。SCC 组的延迟性出血明显少于 PEC 组（2.6% vs. 7.2%；P=0.013）。在接受抗血栓治疗的患者中，SCC 组的延迟性出血率低于 PEC 组，但差异无统计学意义（P=0.15）。SCC 方法是预防延迟性出血的显著独立因素。对 PEC 组和 SCC 组的 156 例患者进行 PSM。PEC 组和 SCC 组的出血发生率存在显著差异（P=0.013）。无患者因 SCC 方法发生穿孔/出血。
我们的研究结果表明，SCC 方法是预防胃 ESD 后延迟性出血的一种简单、安全、有效的方法。
