Arimoto Jun, Chiba Hideyuki, Yamada Keiji, Okada Naoya, Kobayashi Mikio, Kuwabara Hiroki, Nakaoka Michiko, Ohata Ken
Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan.
Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
Endosc Int Open. 2023 Feb 2;11(2):E157-E161. doi: 10.1055/a-1972-3510. eCollection 2023 Feb.
Colorectal angioectasia is a major cause of lower gastrointestinal bleeding. Use of antithrombotic agents is expected to increase with aging of the population, and bleeding from angioectasia is an important issue. Although the effectiveness of endoscopic mucosal resection for colorectal angioectasia has been reported, there are no reports of cold snare technique for angioectasia (CSA). From February 2018 to February 2022, the safety of CSA was evaluated at Omori Red Cross Hospital. We investigated the incidence of bleeding (delayed post-polypectomy bleeding (DPPB) and immediate bleeding) after CSA and the incidence of rebleeding requiring repeated endoscopic treatment. During the study period, 106 angioectasias were identified during colonoscopy. We only targeted patients with bloody stools and/or anemia requiring treatment for bleeding from angioectasia. Finally, we included 11 angioectasias in this study. Rates of DPPB and rebleeding after CSA were 0 %. The rate of immediate bleeding during CSA was 27.3 % (3/11). Dilated capillaries could be observed pathologically in nine of 11 lesions (81.8 %). CSA was safe and can be a new treatment option in the future. To confirm our results and verify the long-term safety and efficacy of CSA, further studies are desirable.
结直肠血管扩张症是下消化道出血的主要原因。随着人口老龄化，抗血栓药物的使用预计会增加，而血管扩张症引起的出血是一个重要问题。虽然已有报道内镜黏膜切除术治疗结直肠血管扩张症的有效性，但尚无关于血管扩张症冷圈套技术（CSA）的报道。2018年2月至2022年2月，大森红十字医院评估了CSA的安全性。我们调查了CSA术后出血（息肉切除术后延迟出血（DPPB）和即时出血）的发生率以及需要重复内镜治疗的再出血发生率。在研究期间，结肠镜检查发现106例血管扩张症。我们仅纳入有便血和/或贫血且需要治疗血管扩张症出血的患者。最终，本研究纳入11例血管扩张症。CSA术后DPPB和再出血率均为0%。CSA术中即时出血率为27.3%（3/11）。11个病变中有9个（81.8%）在病理上可观察到扩张的毛细血管。CSA是安全的，未来可能成为一种新的治疗选择。为证实我们的结果并验证CSA的长期安全性和有效性，需要进一步研究。
