Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon and Seoul, South Korea.
J Dig Dis. 2018 Nov;19(11):657-663. doi: 10.1111/1751-2980.12672. Epub 2018 Nov 11.
Surgicel (Fibrillar), i.e. oxidized regenerated cellulose, is used to control oozing bleeding after surgery, but few studies have assessed its effect on complications after endoscopic treatment. The aim of this study was to evaluate the efficacy of Surgicel for preventing bleeding after endoscopic submucosal dissection (ESD) for gastric epithelial tumors.
From November 2012 to December 2013 patients scheduled for ESD of gastric epithelial tumors were prospectively enrolled in this study. Patients were assigned randomly to monotherapy with a proton pump inhibitor (PPI) (the MT group) or combination therapy with Surgicel and histamine-2 receptor antagonist (H RA) (the CT group) for preventing bleeding after ESD. Major bleeding rates and changes in hemoglobin at 1 and 7 days after ESD were evaluated.
Among the 157 patients enrolled (111 men, 46 women), 78 were assigned to the MT group and 79 to the CT group; finally, 72 and 74 patients were included in the MT and CT groups. The major bleeding rate was lower in the CT group (6/74, 8.1%) than in the MT group (12/72, 16.7%), but the difference was not significant (P = 0.354). The change in hemoglobin was significantly less marked in the CT group than the MT group 1 day after ESD ([-6.2 ± 9.0] g/L vs [-8.9 ± 6.2] g/L, P = 0.045).
Combination therapy with Surgicel and an H RA decreased the rate of bleeding similarly to PPI. Adding Surgicel to H RA could be considered for patients with bleeding tendencies, or who require continuous antiplatelet therapy to prevent bleeding after ESD.
速即纱（纤维状），即氧化再生纤维素，用于控制手术后的渗血，但很少有研究评估其在内镜治疗后并发症的影响。本研究旨在评估速即纱在预防胃上皮肿瘤内镜黏膜下剥离术（ESD）后出血中的疗效。
从 2012 年 11 月至 2013 年 12 月，前瞻性地招募了计划行胃上皮肿瘤 ESD 的患者入组本研究。患者被随机分为质子泵抑制剂（PPI）单药治疗（MT 组）或速即纱联合组胺 2 受体拮抗剂（HRA）治疗（CT 组）以预防 ESD 后出血。评估 ESD 后 1 天和 7 天的主要出血率和血红蛋白变化。
在纳入的 157 例患者中（111 例男性，46 例女性），78 例患者被分配至 MT 组，79 例患者被分配至 CT 组；最终，MT 组和 CT 组分别有 72 例和 74 例患者纳入分析。CT 组的主要出血率（6/74，8.1%）低于 MT 组（12/72，16.7%），但差异无统计学意义（P=0.354）。CT 组 ESD 后 1 天血红蛋白变化明显小于 MT 组[-6.2±9.0]g/L vs [-8.9±6.2]g/L，P=0.045]。
速即纱联合 HRA 的治疗方案与 PPI 相似，可降低出血率。对于有出血倾向或需要持续抗血小板治疗以预防 ESD 后出血的患者，可考虑将速即纱联合 HRA 治疗。
