立即的第二次观察内镜能减少内镜后的粘膜下切割出血吗?
Dong Jun Oh1, Hyoung Jung Na1, Ji Hyung Nam1
1Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
概括
在胃内镜下粘膜切割 (ESD) 后立即进行第二次内镜检查,可以预防早期延迟出血. 这项研究发现,它显著降低了出血风险,特别是大切除,为胃瘤治疗提供了新的策略.
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:
- 胃内镜下粘膜切割 (ESD) 是胃瘤的关键治疗方法.
- 延迟出血是已知的胃ESD的并发症.
- 二次内镜在预防ESD后早期延迟出血的疗效仍未得到充分研究.
研究的目的:
- 调查即时二次观察内镜在预防早期延迟ESD后出血方面的疗效.
- 为了确定与早期延迟ESD后出血相关的风险因素.
主要方法:
- 一项回顾性研究分析了262例胃ESD病例.
- 患者被分为三组:立即第二次观察,预定第二次观察和没有第二次观察内镜.
- 立即的第二次观察内镜被定义为在初始血液静止后不久的重复内镜.
主要成果:
- 整体ESD后出血率为7.3%,其中68.4%被归类为早期延迟出血.
- 立即的二次内镜显著降低了ESD后早期延迟出血的发生率 (3.8%对0.8%,p=0.009).
- 切割样本面积≥1,000mm2是早期延迟出血的一个独立风险因素 (OR 8.98,p=0.010).
结论:
- 立即的第二次观察内镜显示出在胃ESD后预防早期延迟出血的潜力.
- 这种策略可能特别有利于大面积切割的情况.
- 进一步的研究可能会对特定的患者子组完善这种技术的应用.
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