结肠直肠内镜下粘膜切割后延迟出血的风险:利莫日出血评分
Jérémie Albouys1, Sheyla Montori Pina2,3, Safia Boukechiche4
1Hépato-gastro-entérology, Hopital Dupuytren, Limoges, France.
Endoscopy
|October 10, 2023
概括
在结肠直肠内镜下粘膜解剖 (ESD) 后临床显著的延迟出血影响了8.0%的患者. 使用年龄,抗血栓剂,直肠位置,病变大小和ASA得分的新风险评分模型有效预测了这种并发症.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 在瘤学瘤学.
背景情况:
- 临床显著的延迟出血 (CSDB) 是结直肠内镜下粘膜解剖 (ESD) 后的常见不良事件.
- 确定CSDB的风险因素对于患者管理和改善结直肠ESD后的结果至关重要.
研究的目的:
- 评估结直肠ESD后与CSDB相关的风险因素.
- 为CSDB开发和验证一个新的预测风险评分模型.
主要方法:
- 分析了2013年至2022年期间进行的940个结直肠ESD的前性注册表.
- 多变量逻辑回归被用于识别术后长达30天出血延迟的危险因素.
- 开发了一种新的风险评分模型,并进行了内部验证,评估了包括年龄,抗血栓使用,病变位置和大小以及ASA评分在内的因素.
主要成果:
- 在8.0%的患者中,CSDB发生. 之前报道的韩国得分模型表现不佳 (ROC为0.567).
- 确定的主要危险因素是:年龄≥75岁,使用抗血栓剂,直肠位置,病变大小>50毫米,ASA得分为III或IV.
- 新模型显示出良好的区别 (ROC 0.751) 并将患者分为中低风险 (4.1% 出血) 和高风险 (17.5% 出血) 两组.
结论:
- 一个简单的,五个变量的风险评分模型有效地预测了结直肠ESD后的CSDB风险.
- 这一验证得分可以帮助识别高风险患者,并可能指导预防策略和患者咨询.
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