Kanazawa Jun, Ikehara Hisatomo, Horii Toshiki, Kitahara Gen, Betto Tomohiro, Yokoyama Kaoru, Kobayashi Kiyonori, Kusano Chika
Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan.
DEN Open. 2024 Sep 16;5(1):e70008. doi: 10.1002/deo2.70008. eCollection 2025 Apr.
Swift and forced COAG with an electrosurgical knife are commonly used for intraoperative hemostasis in colorectal endoscopic submucosal dissection (ESD). If bleeding cannot be stopped using an electrosurgical knife, cauterization is attempted using hemostatic forceps. Since April 2022, our hospital has started using Spray COAG for intraoperative hemostasis for colorectal ESD. This study aimed to provide evidence of the efficacy of Spray COAG for intraoperative hemostasis.
Colorectal ESD was performed for 320 lesions at our hospital. Of these, 307 were included; 145 and 162 lesions were operated before and after the introduction of Spray COAG, respectively. Spray COAG was used after the change. The primary endpoint was the change in the frequency of use of hemostatic forceps after the introduction of Spray COAG; the secondary endpoint was the change in the prevalence of postoperative complications after the introduction of Spray COAG. It should be noted that the Spray COAG mode was employed solely for hemostasis and not for dissection, while the Swift COAG mode was utilized for dissection in the After Spray COAG group. Statistical analysis was conducted using IPTW analysis.
The frequency of use of hemostatic forceps was significantly decreased after the introduction of Spray COAG (odds ratio = 0.12, 95% confidence interval [95%CI]: 0.06-0.23, < 0.001). The prevalence of post-ESD electrocoagulation syndrome significantly decreased (odds ratio = 0.43, 95%CI: 0.22-0.88, = 0.02). No significant differences were observed between the intraoperative and postoperative perforations or rate of postoperative bleeding.
Spray COAG reduced the frequency of hemostatic forceps use in colorectal ESD.
在结直肠内镜黏膜下剥离术（ESD）中，使用电外科刀进行快速强制凝血常用于术中止血。如果使用电外科刀无法止血，则尝试使用止血钳进行烧灼止血。自2022年4月以来，我院开始使用喷雾凝血法进行结直肠ESD术中止血。本研究旨在提供喷雾凝血法术中止血效果的证据。
我院对320个病变进行了结直肠ESD。其中，307个被纳入研究；分别有145个和162个病变在引入喷雾凝血法之前和之后进行了手术。引入喷雾凝血法后使用了该方法。主要终点是引入喷雾凝血法后止血钳使用频率的变化；次要终点是引入喷雾凝血法后术后并发症发生率的变化。需要注意的是，喷雾凝血模式仅用于止血而非剥离，而在喷雾凝血法后组中，快速凝血模式用于剥离。使用逆概率加权分析（IPTW分析）进行统计分析。
引入喷雾凝血法后，止血钳的使用频率显著降低（优势比=0.12，95%置信区间[95%CI]：0.06-0.23，P<0.001）。ESD后电凝综合征的发生率显著降低（优势比=0.43，95%CI：0.2
