Aoyama Taiki, Takemoto Hiroki, Takeuchi Yukari, Shigita Kenjiro, Asayama Naoki, Fukumoto Akira, Mukai Shinichi, Nagata Shinji
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Endosc Int Open. 2021 Mar;9(3):E356-E362. doi: 10.1055/a-1322-2259. Epub 2021 Feb 19.
Despite the information regarding extravasation from contrast-enhanced computed tomography (CECT), the detectability of the target diverticulum by colonoscopy remains unsatisfactory in colonic diverticular bleeding (CDB). The lack of common signs recognizable on CT and endoscopic images makes it difficult to set a region of interest; however, this can be overcome with the "step-clipping" method, a strategic marking technique for revealing the target. We aimed to investigate the clinical performance of the step-clipping method in patients with CDB. Eighty-seven patients diagnosed with CDB with extravasation using CECT who underwent colonoscopy between August 2007 and February 2020 were included. Patients were divided into two categories: the traditional group (those who underwent colonoscopy from August 2007 to May 2017, n = 54) and the step-clipping group (those who underwent colonoscopy from June 2017 to February 2020, n = 33). The detection rate for the responsible diverticulum was significantly higher in the step-clipping group than in the traditional group (94 % vs 63 %; = .0013). The step-clipping group had a shorter average search time during colonoscopy (9.6 vs 40.5 minutes; < .0001) and lower re-bleeding rate after the initial colonoscopy (6 % vs 26 %; = .02) than the traditional group, which facilitated earlier hospital discharge (5.4 vs 6.8 days; = .027). Colonoscopy using the step-clipping method can improve the detectability of the target lesion within a shorter time, thus leading to lower re-bleeding rates and earlier hospital discharge.
尽管有关于对比增强计算机断层扫描（CECT）外渗的信息，但在结肠憩室出血（CDB）中，结肠镜检查对目标憩室的可检测性仍不尽人意。CT和内镜图像上缺乏可识别的常见征象，使得难以确定感兴趣区域；然而，这可以通过“阶梯式夹取”方法来克服，这是一种用于揭示目标的策略性标记技术。我们旨在研究阶梯式夹取方法在CDB患者中的临床效果。纳入了87例在2007年8月至2020年2月期间接受CECT诊断为CDB并伴有外渗且接受结肠镜检查的患者。患者分为两类：传统组（2007年8月至2017年5月接受结肠镜检查的患者，n = 54）和阶梯式夹取组（2017年6月至2020年2月接受结肠镜检查的患者，n = 33）。阶梯式夹取组中责任憩室的检出率显著高于传统组（94%对63%；P = 0.0013）。阶梯式夹取组在结肠镜检查期间的平均搜索时间较短（9.6分钟对40.5分钟；P < 0.0001），初次结肠镜检查后的再出血率低于传统组（6%对26%；P = 0.02），这有助于更早出院（5.4天对6.8天；P = 0.027）。使用阶梯式夹取方法的结肠镜检查可以在更短时间内提高目标病变的可检测性，从而降低再出血率并实现更早出院。
