非壶腹十二指肠上皮肿瘤内镜切除术后延迟出血的危险因素及高危患者完全黏膜闭合的有效性

Risk factors for delayed bleeding after endoscopic resection of non-ampullary duodenal epithelial tumors and the effectiveness of complete mucosal closure in high-risk patients.

作者信息

Shigeta Kohei, Yoshida Masao, Yamamoto Yoichi, Maeda Yuki, Kawata Noboru, Takada Kazunori, Imai Kenichiro, Hotta Kinichi, Sato Junya, Ishiwatari Hirotoshi, Matsubayashi Hiroyuki, Ono Hiroyuki

机构信息

Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.

出版信息

Surg Endosc. 2025 Feb;39(2):1025-1035. doi: 10.1007/s00464-024-11447-w. Epub 2024 Dec 16.

DOI:10.1007/s00464-024-11447-w

PMID:39681678

Abstract

BACKGROUND

Endoscopic resection (ER) of non-ampullary duodenal epithelial tumors (NADETs) is associated with a high incidence of delayed bleeding (DB). While previous reports have identified composite risk factors for delayed adverse events, including both DB and delayed perforation, the specific factors associated with DB remain unclear. This study aimed to identify factors associated with DB after ER of NADETs.

METHODS

This retrospective study included 335 consecutive patients who underwent ER for a NADET between January 2004 and December 2023. Participants were divided into the DB and non-DB groups. We compared baseline characteristics and clinical outcomes between the two groups to identify factors associated with DB. ER included endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) techniques. DB was defined as bleeding that required endoscopic hemostasis or transfusion after ER. Complete mucosal closure (CMC) was defined as the complete closure of the defect with no endoscopically visible exposure of the defect.

RESULTS

Overall, 128 ESD procedures and 207 non-ESD procedures were performed. DB occurred in 13 patients (3.9%) and its incidence was lower when CMC was achieved (1.1% vs. 13.9%, P < 0.001). Multivariate analysis revealed the use of antithrombotic agents (odds ratio (OR) 3.8; 95% confidence interval (CI): 1.0-14.6, P = 0.048) and a defect circumference ≥ 1/2 (OR 6.2; 95% CI 1.2-30.5, P = 0.029) as risk factors for DB, and CMC (OR 0.19, 95% CI 0.038-0.95, P = 0.043) as a protective factor. Among the 66 patients with risk factors, including the use of antithrombotic agents and/or a defect circumference ≥ 1/2, CMC reduced the incidence of DB (4.5% [2/44], vs. 31.8% [7/22], P = 0.005).

CONCLUSION

We identified significant factors associated with DB after duodenal ER. Particularly, in patients with risk factors for DB, CMC can reduce the incidence of DB.

摘要

背景

非壶腹十二指肠上皮肿瘤（NADETs）的内镜下切除术（ER）与迟发性出血（DB）的高发生率相关。虽然既往报道已确定了包括DB和迟发性穿孔在内的迟发性不良事件的综合风险因素，但与DB相关的具体因素仍不明确。本研究旨在确定NADETs行ER术后与DB相关的因素。

方法

这项回顾性研究纳入了2004年1月至2023年12月期间连续335例行NADETs ER的患者。参与者被分为DB组和非DB组。我们比较了两组的基线特征和临床结局，以确定与DB相关的因素。ER包括内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）技术。DB定义为ER术后需要内镜止血或输血的出血。完全黏膜闭合（CMC）定义为缺损完全闭合，内镜下无可见的缺损暴露。

结果

总体而言，共进行了128例ESD手术和207例非ESD手术。13例患者（3.9%）发生了DB，当实现CMC时其发生率较低（1.1%对13.9%，P<0.001）。多因素分析显示，使用抗血栓药物（比值比（OR）3.8；95%置信区间（CI）：1.0-14.6，P=0.048）和缺损周长≥1/2（OR 6.2；95%CI 1.2-30.5，P=0.029）是DB的危险因素，而CMC（OR 0.19，95%CI 0.038-0.95，P=0.043）是保护因素。在66例有危险因素的患者中，包括使用抗血栓药物和/或缺损周长≥1/2，CMC降低了DB的发生率（4.5%[2/44]对31.8%[7/22]，P=0.005）。