Ishikawa Yumiko, Goto Osamu, Nakagome Shun, Habu Tsugumi, Kirita Kumiko, Koizumi Eriko, Higuchi Kazutoshi, Noda Hiroto, Onda Takeshi, Omori Jun, Akimoto Naohiko, Iwakiri Katsuhiko
Department of Gastroenterology Nippon Medical School, Graduate School of Medicine Tokyo Japan.
Endoscopy Center Nippon Medical School Hospital Tokyo Japan.
JGH Open. 2024 Jul 19;8(7):e70002. doi: 10.1002/jgh3.70002. eCollection 2024 Jul.
During intraoperative bleeding in endoscopic submucosal dissection (ESD), switching to spray coagulation may be beneficial compared with the continuous use of swift coagulation and can reduce the need for hemostatic forceps. We retrospectively assessed the effectiveness of spray modes on intraoperative bleeding during gastric ESD.
A total of 316 bleeding events (156 in the Swift group and 160 in the Spray group) were consecutively recorded. In the Swift group, hemostasis was performed using the swift mode with a retracted tip of the needle-type knife, followed by the hemostatic forceps. In the Spray group, bleeding was treated in a stepwise manner: the swift mode, the spray mode, and the hemostatic forceps. All bleeding events were assigned to one of two groups by an endoscopist who retrospectively reviewed the videos. We compared the use of hemostatic forceps, the total hemostatic time, and the cumulative hemostasis rate between the two groups.The use of hemostatic forceps was significantly lower in the Spray group than in the Swift group (32.7% vs. 13.8%, < 0.001). There was no significant difference in the total hemostatic time (Swift group, 20 s.; Spray group, 16 s.; = 0.42), whereas the cumulative hemostasis rate with the knife was significantly higher in the Spray group ( = 0.007).
The results suggested that spray coagulation from the tip of the needle-type knife could reduce the use of hemostatic forceps. In gastric ESD, spray coagulation may facilitate the hemostasis of intraoperative bleeding.
在内镜黏膜下剥离术（ESD）术中出血时，与持续使用快速凝血相比，切换至喷雾凝血可能有益，且可减少止血钳的使用。我们回顾性评估了喷雾模式对胃ESD术中出血的有效性。
连续记录了316次出血事件（快速组156次，喷雾组160次）。在快速组中，使用针型刀尖端回缩的快速模式进行止血，随后使用止血钳。在喷雾组中，对出血进行逐步处理：快速模式、喷雾模式和止血钳。一名内镜医师通过回顾视频将所有出血事件分配到两组中的一组。我们比较了两组止血钳的使用情况、总止血时间和累积止血率。喷雾组止血钳的使用明显低于快速组（32.7%对13.8%，<0.001）。总止血时间无显著差异（快速组20秒；喷雾组16秒；=0.42），而喷雾组使用刀的累积止血率明显更高（=0.007）。
结果表明，针型刀尖端的喷雾凝血可减少止血钳的使用。在胃ESD中，喷雾凝血可能有助于术中出血的止血。
