预防性结肠ESD (内镜下粘膜解剖) 缺陷关闭对ESD后结果的影响:国际多中心回顾性研究
Rahul Karna1, Jonathan Colón Sánchez2, Kevan Josloff3
1Division of Gastroenterology & Hepatology, University of Minnesota, Minneapolis, MN, 55414, USA. rahulkarnagovind@gmail.com.
Digestive diseases and sciences
|November 5, 2025
概括
结肠内镜下膜解剖 (ESD) 后关闭缺陷显著减少延迟出血和住院过夜. 这种预防性关闭对于右侧的息肉特别有益,改善了患者的治疗结果,并可能使同一天的出院成为可能.
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
- 医疗器械技术 医疗器械技术
背景情况:
- 结肠病变的内镜下粘膜剖析 (ESD) 可以导致延迟不良事件 (DAE),如出血和穿孔.
- 预防性关闭ESD缺陷可以减轻这些风险,并促进当天出院.
研究的目的:
- 为了比较封闭和开放的结肠ESD缺陷之间的DAE发生率和一夜间住院.
- 评估预防性缺陷关闭在减少ESD后并发症方面的有效性.
主要方法:
- 一项西方多中心的回顾性研究,涉及接受结肠ESD (不包括直肠病变) 的患者.
- 在一个完全缺陷关闭的组和一个没有关闭的组之间比较DAE和住院住院.
- 进行多变量分析以确定风险因素和保护措施.
主要成果:
- 在560名患者中,71.8%的患者实现了完整的缺陷关闭.
- 封闭组显示出明显较低的延迟出血率 (1.7%对5.6%,p=0.03).
- 缺陷的关闭降低了延迟出血的风险 (aOR=0.2),特别是在右侧的息肉 (NNT=12.5).
- 恶性息肉增加了穿孔和住院的风险.
- 缺陷关闭 (aOR=0.6) 也显著降低了住院住院的风险.
结论:
- 结肠ESD缺陷的预防性关闭显著减少了延迟出血 (NNT=25.6) 和术后的一夜住院.
- 关闭对右侧的多重体特别有效.
- 建议进行前性研究以验证这些发现.
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