预防性钛夹夹闭预防抗凝治疗患者结直肠内镜黏膜下剥离术后迟发性出血：日本一项多中心回顾性队列研究

Prophylactic clip closure in preventing delayed bleeding after colorectal endoscopic submucosal dissection in patients on anticoagulants: a multicenter retrospective cohort study in Japan.

作者信息

Takada Kazunori, Yoshida Naohisa, Hayashi Yoshikazu, Togo Daichi, Oka Shiro, Fukunaga Shusei, Morita Yoshinori, Hayashi Takemasa, Kozuka Kazuhiro, Tsuji Yosuke, Murakami Takashi, Yamamura Takeshi, Komeda Yoriaki, Takeuchi Yoji, Shinmura Kensuke, Fukuda Hiroko, Yoshii Shinji, Ono Shoko, Katsuki Shinichi, Kawashima Kazumasa, Nemoto Daiki, Yamamoto Hiroyuki, Saito Yutaka, Tamai Naoto, Tamura Aya

机构信息

Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.

Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

出版信息

Endoscopy. 2025 Jun;57(6):631-642. doi: 10.1055/a-2505-7315. Epub 2024 Dec 18.

DOI:10.1055/a-2505-7315

PMID:39694064

Abstract

BACKGROUND

The effectiveness of prophylactic clip closure in reducing the risk of delayed bleeding after colorectal endoscopic submucosal dissection (ESD) is uncertain among patients on anticoagulants. We therefore aimed to assess this effectiveness using data from a large multicenter study.

METHODS

We used the ABCD-J study database to analyze delayed bleeding among 34 455 colorectal ESD cases from 47 Japanese institutions. Delayed bleeding rates among the no/partial and complete closure groups were compared in patients on direct oral anticoagulants (DOACs) or warfarin. Propensity score matching was used for baseline characteristics to reduce the effects of selection bias.

RESULTS

Overall, data from 1478 patients on anticoagulants who underwent colorectal ESD were examined. After propensity score matching, the complete and no/partial closure groups were compared in 212 patients on DOACs and 82 on warfarin. The complete closure group showed a significantly lower delayed bleeding rate in patients receiving DOACs (10.8 % vs. 5.2 %, absolute risk reduction [ARR] 5.7 %, = 0.048) and warfarin (17.1 % vs. 6.1 %, ARR 11.0 %, = 0.049). Additionally, complete closure significantly reduced the risk of delayed bleeding among patients taking DOACs for right-sided lesions (ARR 6.7 %, = 0.04), whereas no risk reduction was observed for left-sided ( > 0.99) or rectal ( = 0.50) lesions. A similar trend was observed among patients on warfarin.

CONCLUSIONS

Prophylactic complete clip closure after colorectal ESD significantly reduced the delayed bleeding rate in patients receiving DOACs or warfarin. It should be performed after ESD, particularly for right-sided lesions.

摘要

背景

在接受抗凝治疗的患者中，预防性钛夹闭合术在降低结直肠内镜黏膜下剥离术（ESD）后迟发性出血风险方面的有效性尚不确定。因此，我们旨在利用一项大型多中心研究的数据评估其有效性。

方法

我们使用ABCD-J研究数据库，分析了来自47家日本机构的34455例结直肠ESD病例的迟发性出血情况。比较了接受直接口服抗凝剂（DOACs）或华法林治疗的患者中，未闭合/部分闭合组和完全闭合组的迟发性出血率。采用倾向评分匹配法来平衡基线特征，以减少选择偏倚的影响。

结果

总体而言，对1478例接受抗凝治疗并进行了结直肠ESD的患者数据进行了检查。经过倾向评分匹配后，对212例接受DOACs治疗的患者和82例接受华法林治疗的患者的完全闭合组与未闭合/部分闭合组进行了比较。在接受DOACs治疗的患者中，完全闭合组的迟发性出血率显著更低（10.8%对5.2%，绝对风险降低[ARR]5.7%，P = 0.048）；在接受华法林治疗的患者中也是如此（17.1%对6.1%，ARR 11.0%，P = 0.049）。此外，完全闭合显著降低了接受DOACs治疗的右侧病变患者的迟发性出血风险（ARR 6.7%，P = 0.04），而左侧（P>0.99）或直肠（P = 0.50）病变患者未观察到风险降低。在接受华法林治疗的患者中也观察到了类似趋势。