预防性直肠ESD (内镜下粘膜解剖) 缺陷关闭和ESD后临床结果:一项国际多中心研究 (附视频)
Anand R Kumar1, Pranita Madaka2, Joria Le3
1Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Anand.Kumar@jefferson.edu.
预防性关闭直肠内镜粘膜下解剖 (ESD) 缺陷显著减少了夜间住院观察. 虽然没有减少整体延迟不良事件 (DAE),但在高风险患者中选择性关闭需要进一步研究.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 外科手术的结果
背景情况:
- 内镜下粘膜剖析 (ESD) 是一种微创的技术,用于消化肠道病变的去除.
- 在ESD后可能发生延迟不良事件 (DAE),如出血和穿孔.
- 建议预防性关闭ESD缺陷以减轻这些DAE,但证据有限.
研究的目的:
- 评估预防性关闭直肠ESD缺陷对ESD后结果的影响.
- 为了比较封闭和开放的ESD缺陷之间的DAE率和住院.
主要方法:
- 国际多中心回顾性队列研究 (2016-2023).
- 包括接受直肠ESD的患者,可进行2周的随访.
- 在缺陷关闭和开放缺陷组之间比较DAE (出血,穿孔) 和住院治疗.
主要成果:
- 包括385名患者;43%的缺陷已关闭.
- 总体而言,DAE率为5.5%,为5.5%.
- 缺陷关闭显著减少了夜间住院观察 (17%vs37%,p<0.01) 并没有显示延迟穿孔 (0%vs1.3%).
- DAE的高风险因素包括抗凝剂使用,NICE 3病变和不完全切除.
结论:
- 预防性直肠ESD缺陷关闭显著降低了医院一夜间观察的需要.
- 虽然没有显著减少整体的DAE,但关闭可能有利于高风险群体.
- 需要对更大的样本进行进一步的研究,以确认选择性预防性关闭在高风险患者中的有效性.
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