Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea; Department of Internal Medicine, Myongji Hospital, Goyang, Republic of Korea.
Arab J Gastroenterol. 2023 Nov;24(4):245-250. doi: 10.1016/j.ajg.2023.09.004. Epub 2023 Nov 22.
Gastric endoscopic submucosal dissection (ESD) is a curative treatment for gastric neoplasm. A scheduled second-look endoscopy could be performed to prevent delayed post-ESD bleeding. However, no studies on the efficacy of second-look endoscopy for the prevention of early delayed post-ESD bleeding have been conducted. So, the aim of this study was to be the first to investigate the efficacy of immediate second-look endoscopy for the prevention of post-ESD bleeding.
The 266 gastric ESD cases were included. Immediate second-look endoscopy was defined as repeated upper endoscopy soon after complete hemostasis of the ESD site and specimen fixation. Early and late delayed bleeding were classified as before or after 24 h after the ESD, respectively.
The 262 ESD cases were enrolled and divided into three groups: the immediate second-look (n = 79), scheduled second-look (n = 86), and no second-look (n = 97). Post-ESD bleeding occurred in 19 cases (7.3%). Of these, 13 (68.4%) were early delayed post-ESD bleeding. The immediate second-look endoscopy had a lower incidence of early delayed post-ESD bleeding compared to the groups without immediate second-look endoscopy, (3.8% vs. 0.8%, p = 0.009). In a multivariate analysis, immediate second-look endoscopy significantly reduced early delayed post-ESD bleeding (OR 0.39, p = 0.022). The resected specimen area ≥ 1,000 mm was an independent risk factor for early delayed post-ESD bleeding (OR 8.98, p = 0.010). However, the frequency of delayed post-ESD bleeding did not differ between the three groups.
Immediate second-look endoscopy after gastric ESD may prevent early delayed post-ESD bleeding under certain circumstances.
胃内镜黏膜下剥离术（ESD）是一种治疗胃肿瘤的方法。可以进行计划性的二次内镜检查，以预防延迟性 ESD 后出血。然而，目前尚无关于二次内镜检查预防早期延迟性 ESD 后出血的疗效的研究。因此，本研究旨在首次探讨即刻二次内镜检查预防 ESD 后出血的疗效。
共纳入 266 例胃 ESD 病例。即刻二次内镜检查定义为在 ESD 部位完全止血和标本固定后立即进行重复上消化道内镜检查。早期和晚期延迟性出血分别定义为 ESD 后 24 小时内和 24 小时后发生的出血。
纳入 262 例 ESD 病例，分为三组：即刻二次内镜检查组（n=79）、计划性二次内镜检查组（n=86）和无二次内镜检查组（n=97）。ESD 后出血 19 例（7.3%）。其中，13 例（68.4%）为早期延迟性 ESD 后出血。与无即刻二次内镜检查组相比，即刻二次内镜检查组早期延迟性 ESD 后出血发生率较低（3.8% vs. 0.8%，p=0.009）。多因素分析显示，即刻二次内镜检查显著降低了早期延迟性 ESD 后出血的风险（OR 0.39，p=0.022）。切除标本面积≥1000mm²是早期延迟性 ESD 后出血的独立危险因素（OR 8.98，p=0.010）。然而，三组间延迟性 ESD 后出血的发生率无差异。
在某些情况下，胃 ESD 后即刻进行二次内镜检查可能预防早期延迟性 ESD 后出血。
