Related Experiment Videos
Risk-stratified evaluation of prophylactic strategies for delayed bleeding after gastric ESD: a multicenter
S Abiko1,2,3,4, K Kinoshita1, H Oda2
1Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan.
Background And Study Aims:
Delayed bleeding (DB) remains a major complication after gastric endoscopic submucosal dissection (ESD), and risk-stratified preventive strategies are not well established. This study evaluated the efficacy of the modified search, coagulation, and clipping (MSCC) method and MSCC combined with polyglycolic acid sheets and fibrin glue (PMSCC) using the Bleeding after ESD Trend from Japan (BEST-J) score.
Patients And Methods:
We retrospectively analyzed 303 patients who underwent gastric ESD with MSCC or PMSCC between April 2018 and March 2024. DB was defined as bleeding requiring emergency endoscopic hemostasis or transfusion, or a hemoglobin decrease ≥ 2 g/dL. Observed DB rates were compared with threshold rates derived from the BEST-J score.
Results:
In the low-risk category (MSCC/PMSCC: 237/0), no DB occurred in the MSCC group (0%; 95% confidence interval [CI]: 0.00-1.54%), with the upper CI limit below the threshold rate (2.8%). In the intermediate-risk category, DB occurred in one patient in the MSCC group (1/29; 3.4%; 95% CI: 0.08-17.8%), and no DB was observed in the PMSCC group (0/3; 0.0%; 95% CI: 0.00-70.8%); the confidence intervals overlapped the threshold rate (6.1%). In the high-risk category, DB occurred in 1/4 (25.0%; 95% CI: 0.63-80.6%) and 5/30 (16.7%; 95% CI: 5.6-34.7%) patients in the MSCC and PMSCC groups, respectively; neither the observed rate nor its confidence interval fell below the threshold rate (11.4%).
Conclusions:
The MSCC method is an effective prophylactic strategy for preventing DB in the low-risk category as defined by the BEST-J score.
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails...