Kobayashi Nobuya, Kobara Hideki, Nishiyama Noriko, Tani Joji, Chiyo Taiga, Kozuka Kazuhiro, Tada Naoya, Matsui Takanori, Fujihara Shintaro, Yachida Tatsuo, Fujita Koji, Kondo Akihiro, Okano Keiichi, Nishiyama Akira, Masaki Tsutomu
Department of Gastroenterology and Neurology, Faculty of Medicine (Nobuya Kobayashi, Hideki Kobara, Noriko Nishiyama, Joji Tani, Taiga Chiyo, Kazuhiro Kozuka, Naoya Tada, Takanori Matsui, Shintaro Fujihara, Tatsuo Yachida, Koji Fujita, Tsutomu Masaki).
Department of Gastroenterological Surgery, Faculty of Medicine (Akihiro Kondo, Keiichi Okano).
Ann Gastroenterol. 2023 Mar-Apr;36(2):178-184. doi: 10.20524/aog.2023.0771. Epub 2023 Jan 2.
The management of delayed bleeding after gastric endoscopic submucosal dissection (ESD) is currently an important issue because of recent increases in the number of patients on antithrombotic therapy. Artificial ulcer closure has been shown to prevent delayed complications in the duodenum and colon. However, its effectiveness in cases involving the stomach remains unclear. In this study, we aimed to determine whether endoscopic closure reduces post-ESD bleeding in patients undergoing antithrombotic therapy.
We retrospectively analyzed 114 patients who had undergone gastric ESD while on antithrombotic therapy. The patients were allocated to one of 2 groups: a closure group (n=44) and a non-closure group (n=70). Endoscopic closure had been performed using multiple hemoclips or using the endoscopic ligation with O-ring closure method after coagulation of exposed vessels on the artificial floor. Propensity score matching resulted in 32 pairs of patients (closure vs. non-closure 32:32). The primary outcome was post-ESD bleeding.
The post-ESD bleeding rate was significantly lower in the closure group (0%) than in the non-closure group (15.6%) (P=0.0264). There were no significant differences between the 2 groups regarding white blood cell count, C-reactive protein, maximum body temperature, or scores on a verbal rating scale that assesses the degree of abdominal pain.
Endoscopic closure may contribute to decreasing the incidence of post-ESD gastric bleeding in patients undergoing antithrombotic therapy.
由于接受抗血栓治疗的患者数量近期有所增加，胃内镜黏膜下剥离术（ESD）后延迟出血的管理目前是一个重要问题。人工溃疡闭合已被证明可预防十二指肠和结肠的延迟并发症。然而，其在胃部病例中的有效性仍不明确。在本研究中，我们旨在确定内镜闭合是否能减少接受抗血栓治疗的患者ESD术后出血。
我们回顾性分析了114例在接受抗血栓治疗期间接受胃ESD的患者。患者被分为两组之一：闭合组（n = 44）和非闭合组（n = 70）。在内镜下对人工创面暴露血管进行凝血后，使用多个止血夹或采用内镜套扎O形圈闭合法进行内镜闭合。倾向评分匹配产生了32对患者（闭合组与非闭合组32:32）。主要结局是ESD术后出血。
闭合组的ESD术后出血率（0%）显著低于非闭合组（15.6%）（P = 0.0264）。两组在白细胞计数、C反应蛋白、最高体温或评估腹痛程度的语言评定量表评分方面无显著差异。
内镜闭合可能有助于降低接受抗血栓治疗的患者ESD术后胃出血的发生率。
