Department of Medicine, Columbia University Irving Medical Center, New York Presbyterian Hospital, 5141 Broadway, New York, NY 10034, USA.
Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York Presbyterian Hospital, Herbert Irving Pavilion, 161 Fort Washington Avenue, 8th Floor, Street 852A, New York, NY 10032, USA.
Gastrointest Endosc Clin N Am. 2023 Jan;33(1):183-196. doi: 10.1016/j.giec.2022.09.005.
The risk-benefit profile of submucosal endoscopic procedures is generally favorable but there exist unique considerations regarding the recognition, treatment, and prevention of submucosal endoscopic complications. Bleeding during the procedure can be managed with knife electrocautery, tamponade by injection of additional submucosal agent, or hemostatic forceps, depending on the location and degree of bleeding. Delayed bleeding should be managed with repeat endoscopy. Potential means to reduce the risk of delayed bleeding include anticipatory coagulation of visible vessels in the dissection ulcer base, applied hemostatic chemicals, snares, clips, and sheets of cultured cells.
黏膜下内镜手术的风险效益比通常是有利的，但在识别、治疗和预防黏膜下内镜并发症方面存在一些特殊的考虑因素。根据出血的位置和程度，可以使用电刀、额外黏膜下注射剂填塞或止血夹进行处理。延迟性出血应通过重复内镜检查进行处理。减少延迟性出血风险的潜在方法包括在解剖溃疡底部可见血管时进行预期性凝固、应用止血化学物质、套扎器、夹子和培养细胞片。
