aspiration and coagulation to reduce risk of delayed bleeding after gastric endoscopic submucosal dissection (with video) aspiration and coagulation 用于减少胃内镜黏膜下剥离术后迟发性出血的风险（附视频）

Aspiration and coagulation to reduce risk of delayed bleeding after gastric endoscopic submucosal dissection (with video).

机构信息

Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China.

Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.

出版信息

Dig Endosc. 2024 Jun;36(6):699-707. doi: 10.1111/den.14704. Epub 2023 Nov 22.

DOI:10.1111/den.14704

PMID:37843496

Abstract

OBJECTIVES

The purpose of this study was to evaluate the feasibility of a simple method named aspiration and coagulation (AC) for reducing the risk of postoperative bleeding after gastric endoscopic submucosal dissection (ESD).

METHODS

Data were retrospectively reviewed and collected from the medical records and endoscopic and pathologic reports about consecutive patients who underwent ESD for early gastric cancer or precancerous lesions or gastric submucosal lesions from January 2016 to December 2021 at the Seventh Medical Center of Chinese PLA General Hospital. Enrolled patients who underwent the AC method during ESD were included in the AC group, and the others were included in the control group. Propensity score (PS) matching (1:1 match) was used to compensate for the differences that might affect post-ESD bleeding. Massive hemorrhage and overall delayed bleeding events after gastric ESD were compared between the two groups.

RESULTS

Propensity score matching analysis created 242 matched pairs in the study. Characteristics of the subjects such as age and use of antithrombotic drugs were all similar between the two groups after PS matching. The rate of massive hemorrhage and overall delayed bleeding was both significantly lower in the AC group than in the control (0.4% vs. 3.3% for massive hemorrhage, P = 0.037, and 1.2% vs. 5.0% for overall delayed bleeding, P = 0.032), predominantly in mucosal lesions (0.6% vs. 4.4% for massive hemorrhage, P = 0.032, and 1.2% vs. 5.6% for overall delayed bleeding, P = 0.031).

CONCLUSIONS

Our study demonstrated that the AC method effectively decreased delayed bleeding events after ESD.

摘要

目的

本研究旨在评估一种名为吸引和凝固（AC）的简单方法在降低胃内镜黏膜下剥离（ESD）后出血风险中的可行性。

方法

回顾性收集 2016 年 1 月至 2021 年 12 月解放军总医院第七医学中心连续接受 ESD 治疗的早期胃癌或癌前病变或胃黏膜下病变患者的病历、内镜和病理报告资料。将 ESD 过程中采用 AC 方法的患者纳入 AC 组，其他患者纳入对照组。采用倾向评分（PS）匹配（1:1 匹配）来补偿可能影响 ESD 后出血的差异。比较两组患者胃 ESD 后大出血和总体延迟性出血事件的发生率。

结果

PS 匹配分析共创建了 242 对匹配。PS 匹配后，两组患者的年龄和抗血栓药物使用等特征均相似。AC 组大出血和总体延迟性出血的发生率均明显低于对照组（大出血：0.4% vs. 3.3%，P=0.037；总体延迟性出血：1.2% vs. 5.0%，P=0.032），主要在黏膜病变中（大出血：0.6% vs. 4.4%，P=0.032；总体延迟性出血：1.2% vs. 5.6%，P=0.031）。