Prophylactic clip closure for mucosal defects is associated with reduced adverse events after colorectal endoscopic submucosal dissection: a propensity-score matching analysis.
Prophylactic clip closure for mucosal defects is associated with reduced adverse events after colorectal endoscopic submucosal dissection: a propensity-score matching analysis.
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DOI：
10.1186/s12876-022-02202-3
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发表时间：
2022-03-26
影响因子：
2.4
通讯作者：
Iwakiri K
中科院分区：
文献类型：
--
作者：
Omori J;Goto O;Habu T;Ishikawa Y;Kirita K;Koizumi E;Noda H;Higuchi K;Onda T;Akimoto T;Akimoto N;Itokawa N;Kaise M;Iwakiri K
目前尚不清楚结直肠内镜黏膜下剥离术（ESD）后预防性内镜闭合是否能降低因病变特征的变异性而导致的术后不良事件的风险。因此，我们使用倾向评分匹配进行了一项回顾性研究，以评价预防性结扎夹闭合在预防结直肠ESD术后不良事件方面的有效性。这项单中心回顾性队列研究纳入了219例通过ESD切除的结直肠肿瘤。将患者分为闭合组和非闭合组，在倾向评分匹配前后进行比较。比较两组ESD后的不良事件，包括大出血、小出血和迟发性穿孔。在本研究中，分别将97和122处病变分配至闭合组和非闭合组，倾向评分匹配创建了61对匹配对。闭合组的不良事件发生率显著低于非闭合组（8% vs. 28%，P = 0.008）。非闭合组有2例患者发生延迟穿孔，而闭合组无患者发生延迟穿孔。相比之下，两组之间的其他术后事件无显著差异，包括腹痛发生率;发热、白色血细胞计数和C反应蛋白;以及食欲不振。倾向评分匹配分析表明，预防性闭合与结直肠ESD后不良事件发生率显著降低相关。在技术上可行的情况下，结直肠ESD后的粘膜缺损闭合可能会导致良好的术后病程。
It is unclear whether prophylactic endoscopic closure after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events due to variability in lesion characteristics. Therefore, we conducted a retrospective study using propensity score matching to evaluate the efficacy of prophylactic clip closure in preventing postoperative adverse events after colorectal ESD. This single-center retrospective cohort study included 219 colorectal neoplasms which were removed by ESD. The patients were allocated into the closure and non-closure groups, which were compared before and after propensity-score matching. Post-ESD adverse events including major and minor bleeding and delayed perforation were compared between the two groups. In this present study, 97 and 122 lesions were allocated to the closure and non-closure groups, respectively, and propensity score matching created 61 matched pairs. The rate of adverse events was significantly lower in the closure group than in the non-closure group (8% vs. 28%, P = 0.008). Delayed perforation occurred in two patients in the non-closure group, whereas no patient in the closure group developed delayed perforation. In contrast, there were no significant differences in other postoperative events including the rate of abdominal pain; fever, white blood cell count, and C-reactive protein; and appetite loss between the two groups. Propensity score matching analysis demonstrated that prophylactic closure was associated with a significantly reduced rate of adverse events after colorectal ESD. When technically feasible, mucosal defect closure after colorectal ESD may result in a favorable postoperative course.