Kim Sang Hoon, Lee Jun Kyu, Lim Yun Jeong, Kim Jae Hak
Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Dongguk-ro 27 Ilsandong-gu, Goyang, 10326, Republic of Korea.
Surg Endosc. 2022 Feb;36(2):1123-1130. doi: 10.1007/s00464-021-08379-0. Epub 2021 Feb 24.
Endoscopic hemostatic clipping is a safe and efficient treatment used to manage bleeding or perforation during endoscopic submucosal dissection (ESD) for gastric neoplasm. However, the natural history of applied hemoclips during ESD has not been elucidated. As prolonged clip retention limits the use of magnetic resonance imaging and may impede the ulcer healing process, we investigated the factors associated with prolonged hemoclip retention during gastric ESD.
We retrospectively reviewed 199 patients who underwent gastric ESD with hemoclip application from January 2006 to January 2019. The primary outcome was the prolonged hemoclip retention rate 3 months after ESD. We examined the records of subjects followed at 3, 6, and 12 months and then annually after ESD to monitor clip retention.
The prolonged hemoclip retention rate at 3 months was 27.1% (54/199). The risk of hemoclip retention was significantly lower at the antrum (19.6%, P = 0.03). Hemoclips at the angle tended to remain longer than other locations in the stomach (40.6%, P = 0.081) while there was no difference in the number of applied clips depending upon the location of the lesion. By Kaplan-Meier survival analysis, clips at the antrum detached significantly earlier than those at other locations (P = 0.011).
Most of the hemostatic clips attached during ESD were spontaneously removed by 3 months after gastric ESD. However, clips positioned at angle are suspected to have a high probability of prolonged retention. With this in mind, more attention is needed when using hemoclips on angle.
内镜下止血夹闭术是一种安全有效的治疗方法，用于处理胃肿瘤内镜黏膜下剥离术（ESD）期间的出血或穿孔。然而，ESD期间应用止血夹的自然病程尚未阐明。由于延长的夹子留置会限制磁共振成像的使用，并可能阻碍溃疡愈合过程，我们研究了胃ESD期间与止血夹延长留置相关的因素。
我们回顾性分析了2006年1月至2019年1月期间接受胃ESD并应用止血夹的199例患者。主要结局是ESD后3个月止血夹延长留置率。我们检查了ESD后3、6和12个月以及之后每年随访的受试者记录，以监测夹子留置情况。
3个月时止血夹延长留置率为27.1%（54/199）。胃窦部止血夹留置的风险显著较低（19.6%，P = 0.03）。胃角部的止血夹往往比胃内其他部位留置时间更长（40.6%，P = 0.081），而根据病变部位应用的夹子数量没有差异。通过Kaplan-Meier生存分析，胃窦部的夹子比其他部位的夹子脱落明显更早（P = 0.011）。
ESD期间附着的大多数止血夹在胃ESD后3个月内会自行脱落。然而，位于胃角部的夹子被怀疑有延长留置的高概率。考虑到这一点，在胃角部使用止血夹时需要更多关注。
