Early Covered Self-Expandable Metal Stent Placement Is Effective for Massive Post-endoscopic Sphincterotomy Bleeding
Early Covered Self-Expandable Metal Stent Placement Is Effective for Massive Post-endoscopic Sphincterotomy Bleeding
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DOI：
10.1007/s10620-020-06057-0
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发表时间：
2020-01-16
影响因子：
3.1
通讯作者：
Yoneda, Masashi
中科院分区：
文献类型：
--
作者：
Inoue, Tadahisa;Ibusuki, Mayu;Yoneda, Masashi
背景放置覆膜自膨式金属支架（CSEMS）治疗内镜下括约肌切开术（ES）后出血可获得良好的止血效果。虽然CSEMS放置通常在传统内镜联合治疗失败后进行，但其良好的结局可能证明早期放置是合理的。目的：我们旨在研究“早期”CSEMS放置对ES后大出血的疗效。方法回顾性分析2005年至2019年2750例ES患者的病历资料，其中61例ES术后发生大出血。这些患者分为接受早期CSEMS放置的患者（E-CSEMS组）和接受常规内镜联合治疗的患者（常规组）。比较两组的止血结果。结果E-CSEMS组和常规组的内镜下止血一次成功率分别为100%（21/21）和98%（39/40），差异无统计学意义（P = 1.000）。然而，在E-CSEMS组中，再出血的频率显著较低（5% vs. 31%; P = 0.023），中位止血手术时间显著较短（14 min vs. 26 min; P < 0.001），初始止血治疗后输血的需求较少（10% vs. 38%; P = 0.034）。多变量分析显示，血液透析与显著较高的再出血率相关（P = 0.029），而CSEMS放置与显著较低的再出血率相关（P = 0.039）。结论早期放置CSEMS可减少ES术后大出血的再出血，减少出血范围，改善临床疗效。
Background Placement of covered self-expandable metallic stent (CSEMS) for post-endoscopic sphincterotomy (ES) bleeding achieves excellent hemostasis results. Although CSEMS placement is typically performed after failure of conventional endoscopic combination therapy, its excellent outcomes may justify earlier placement. Aims We aimed to examine the efficacy of "early" CSEMS placement for massive post-ES bleeding. Methods The medical records of 2750 patients who underwent ES between 2005 and 2019 were reviewed retrospectively, and 61 patients who developed massive post-ES bleeding were enrolled. These patients were divided into those who underwent early CSEMS placement (E-CSEMS group) and those who underwent conventional endoscopic combination therapy (Conventional group). The outcomes of hemostasis procedures were compared between the groups. Results The primary success rates of endoscopic hemostasis were 100% (21/21) and 98% (39/40) in the E-CSEMS group and Conventional group, respectively, without significant differences (P = 1.000). However, in the E-CSEMS group, re-bleeding was significantly less frequent (5% vs. 31%; P = 0.023), the median hemostasis procedure time was significantly shorter (14 min vs. 26 min; P < 0.001), and transfusion after initial hemostasis treatment was less commonly required (10% vs. 38%; P = 0.034). Multivariate analyses showed that hemodialysis was associated with a significantly higher re-bleeding rate (P = 0.029), while CSEMS placement was associated with a significantly lower re-bleeding rate (P = 0.039). Conclusions Early CSEMS placement may be effective for improving the clinical outcomes of massive post-ES bleeding by decreasing re-bleeding and the extent of bleeding.