Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashi-cho Chuo-ku, Tokyo, Japan.
Department of Gastroenterology, Sherbrooke University Hospital, Sherbrooke, QC, Canada.
Surg Endosc. 2022 Nov;36(11):8663-8671. doi: 10.1007/s00464-022-09345-0. Epub 2022 Jun 13.
Prophylactic coagulation after gastric endoscopic submucosal dissection (ESD) decreases the rate of delayed bleeding; however, it cannot prevent bleeding completely, and delayed bleeding may occur from non-exposed vessels that were not detected immediately after ESD or where prophylactic coagulation was inadequate. Doppler monitoring systems which can evaluate vascular flow have been recently introduced in the endoscopic field. We developed the Doppler probe method (DOP) using the novel system and conducted a comparative study.
Data were retrospectively collected at a tertiary hospital between January 2017 and May 2021. Patients who underwent DOP were matched to those who did not (no-DOP, 1:3 ratio). After successful ESD, DOP was performed, and coagulation was additionally performed as necessary. The primary outcome was the rate of 30-day delayed bleeding.
Fifty DOP patients were matched to 151 no-DOP patients. Although the differences were not statistically significant, the DOP group had lower rates of delayed bleeding (2.0% vs. 8.6%, P = 0.11; risk differences, 6.6%; 95% confidence interval [CI] 1.2-12.1%), readmission due to bleeding (0% vs. 2.7%), and blood transfusion (2.0% vs. 3.3%) compared to the no-DOP group. In the whole study population (n = 245), the log-rank test revealed that DOP was correlated to a lower incidence of delayed bleeding (P = 0.036). The Cox regression model revealed a marginally significant effect on delayed bleeding (hazard ratio = 0.17, 95% CI 0.022-1.26, P = 0.082). No procedure-related adverse events were observed.
DOP is safe and may reduce delayed bleeding; however, further prospective studies are required to validate our findings.
胃内镜黏膜下剥离术（ESD）后预防性止血可降低延迟性出血的发生率；但并不能完全止血，延迟性出血可能来自ESD 后即刻未被发现的未暴露血管，或预防性止血不足的部位。最近在内镜领域引入了可以评估血管血流的多普勒监测系统。我们使用该新型系统开发了多普勒探头法（DOP）并进行了对比研究。
在一家三级医院回顾性收集 2017 年 1 月至 2021 年 5 月的数据。DOP 组与未进行 DOP 组（1:3 比例）相匹配。ESD 成功后，进行 DOP 检查，并根据需要进行额外的凝血治疗。主要结局是 30 天延迟性出血的发生率。
50 例 DOP 患者与 151 例未进行 DOP 患者相匹配。尽管差异无统计学意义，但 DOP 组延迟性出血发生率较低（2.0% vs. 8.6%，P=0.11；风险差异，6.6%；95%置信区间[CI] 1.2-12.1%）、因出血再次入院率（0% vs. 2.7%）和输血率（2.0% vs. 3.3%）低于未进行 DOP 组。在整个研究人群（n=245）中，对数秩检验显示 DOP 与较低的延迟性出血发生率相关（P=0.036）。Cox 回归模型显示 DOP 对延迟性出血有边缘显著影响（危险比=0.17，95%CI 0.022-1.26，P=0.082）。未观察到与操作相关的不良事件。
DOP 安全且可能降低延迟性出血的发生率；但需要进一步的前瞻性研究来验证我们的发现。
