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Risk factors for delayed bleeding by onset time after endoscopic submucosal dissection for gastric neoplasm

机译:胃癌内镜下黏膜下剥离术后发病时间延迟出血的危险因素

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Post-endoscopic submucosal dissection bleeding (PEB) is one of the important complications after endoscopic submucosal dissection (ESD), but still difficult to predict. The present study aimed to identify significant risk factors for PEB according to onset time. Between November 2008 and January 2016, a total of 1864 lesions resected via ESD were analyzed. PEB was classified as either early or late according to onset time (within or after 24?hours post-ESD, respectively). During second-look endoscopy, the artificial ulcer bed was subjected to Forrest classification. A high risk of stigma was defined as active spurting bleeding, oozing bleeding, and a non-bleeding visible vessel in the ulcer. The endoscopic factors and medications associated with PEB were analyzed. PEB occurred in 77 lesions (4.1%): early only in 46 (2.4%), late only in 22 (1.1%), and early and late in 9 (0.4%). Among 55 early PEB events, 25 were asymptomatic and diagnosed during second-look endoscopy. Age ≤65 years, resection size ≥30?mm, procedure time ≥20?min, lower third of the stomach, erosion, and clopidogrel use were significantly associated with early PEB. If the number of risk factors were ≤1, the risk of early PEB was 0.6%. For late PEB, the mid to upper third of the stomach, undifferentiated carcinoma, erosion, high risk of stigma during second-look endoscopy, history of early PEB, and clopidogrel use were significant risk factors. If risk factors were absent, the risk of late PEB was 0.1%. For patients at high risk of early PEB, selective second-look endoscopy might be a useful. For patients at high risk of late PEB, careful monitoring of bleeding should be considered.
机译:内镜下黏膜下剥离术出血(PEB)是内镜下黏膜下剥离术(ESD)的重要并发症之一,但仍难以预测。本研究旨在根据发病时间确定PEB的重要危险因素。在2008年11月至2016年1月之间,总共对1864个通过ESD切除的病变进行了分析。根据发病时间(分别在ESD后24小时之内或之后)将PEB分为早期或晚期。在第二眼内窥镜检查期间,对人造溃疡床进行了Forrest分类。柱头的高风险定义为活动性喷血,渗血和溃疡中可见血管无出血。分析与PEB相关的内窥镜因素和药物。 PEB发生在77个病变中(4.1%):早期只有46个(2.4%),晚期只有22个(1.1%),早期和晚期9个(0.4%)。在55例早期PEB事件中,有25例是无症状的,在第二眼内窥镜检查中被诊断出。年龄≤65岁,切除尺寸≥30?mm,手术时间≥20?min,胃下三分之一,糜烂和使用氯吡格雷与早期PEB显着相关。如果危险因素的数量≤1,则早期PEB的风险为0.6%。对于晚期PEB,胃中上半部,未分化癌,糜烂,第二眼内窥镜检查期间柱头的高风险,早期PEB的病史和使用氯吡格雷是重要的危险因素。如果没有危险因素,则晚期PEB的风险为0.1%。对于有早期PEB高风险的患者,选择性第二眼内窥镜检查可能是有用的。对于晚期PEB高危患者,应考虑仔细监测出血情况。

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