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Vessel coagulation in third-space endoscopy: a randomized controlled trial.

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Summary
This summary is machine-generated.

Saline-immersion pre-sealing significantly reduces intraprocedural bleeding during third-space endoscopy procedures. This novel technique enhances patient safety by minimizing bleeding events and the need for additional interventions.

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Area of Science:

  • Gastroenterology
  • Endoscopic Surgery
  • Minimally Invasive Procedures

Background:

  • Third-space endoscopy is crucial for neoplastic and motility disorders but carries a high risk of bleeding.
  • Conventional methods to mitigate bleeding involve instrument exchange, adding complexity.
  • A novel approach utilizes saline immersion for pre-sealing submucosal vessels.

Purpose of the Study:

  • To evaluate the efficacy of saline-immersion pre-sealing in reducing intraprocedural bleeding during third-space endoscopy.
  • To compare saline-immersion pre-sealing with conventional coagulation methods.
  • To assess the impact on bleeding rates, need for retreatment, and coagulation time.

Main Methods:

  • A randomized controlled trial comparing saline-immersion pre-sealing (study group) versus conventional coagulation (control group).
  • Patients undergoing endoscopic submucosal dissection (ESD) or peroral endoscopic myotomy (POEM) were included.
  • The primary outcome was the per-patient rate of intraprocedural bleeding requiring retreatment for vessels ≥1.2 mm.

Main Results:

  • Saline-immersion pre-sealing significantly reduced bleeding rates per patient (32.4% vs. 75.8%) and per vessel (6.3% vs. 29.9%).
  • The need for adjunctive coagulation devices decreased significantly in the saline-immersion group (0% vs. 24.2%).
  • Coagulation time was also significantly reduced with saline-immersion pre-sealing (22.7s vs. 29.6s).

Conclusions:

  • Saline-immersion pre-sealing offers a substantial reduction in intraprocedural bleeding risk during third-space endoscopy.
  • The technique proved effective in both per-patient and per-vessel analyses.
  • These findings support the implementation of saline-immersion pre-sealing in clinical practice.