Efficacy of endoscopic clip closure for nonperforated muscle layer exposure during esophageal endoscopic submucosal dissection
Efficacy of endoscopic clip closure for nonperforated muscle layer exposure during esophageal endoscopic submucosal dissection
复制标题
食管内镜粘膜下剥离术中内镜夹闭合对非穿孔肌层暴露的疗效
DOI：
10.1093/dote/doac009
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发表时间：
2022
期刊：
影响因子：
2.6
通讯作者：
Itoi T
中科院分区：
文献类型：
--
作者：
Yamaguchi H;Fukuzawa M;Kawai T;Uchida K;Koyama Y;Madarame A;Morise T;Sugimoto A;Kono S;Naito S;Itoi T
在内窥镜下食道粘膜下剥离术(ESD)中暴露肌层可能会导致发烧和疼痛等并发症。虽然在穿孔是主要并发症的情况下，内窥镜下夹子缝合被广泛使用，但当暴露的肌层没有穿孔时，其价值尚不清楚。对2008-2020年间接受ESD治疗的104例患者的104个病变的资料进行了回顾分析。排除了患有多发性肿瘤的患者，那些经历了吸入性肺炎、ESD期间穿孔或延迟出血等与手术相关的不良事件的患者，以及那些没有暴露肌肉层的患者。根据是否使用内窥镜夹子闭合，检查暴露肌肉层的患者ESD后炎症的临床过程。夹闭组患者的体温 ≤ 为37.5C，明显高于非夹闭组(≤37.5C/≥37.6C，47/14vs.25/18，P= 0.040)。此外，闭合组患者在ESD24小时内白细胞计数≤10,000/μL(≤10,000/μL/>；10,000/μL，51/10比21/22，P<； 0.001)和C反应蛋白水平 <； 1.0 mg/dL(<；1.0 mg/dL/≥1.0 mg/dL，40/21比36/7，P= 0.040)显著增加。倾向分数匹配后，结果没有改变。内窥镜夹闭合可减少无穿孔肌层暴露的食道ESD后的炎症。即使在ESD过程中没有明显的穿孔，用内窥镜夹子关闭暴露的肌层也可能有助于ESD后的临床过程。
Exposure of the muscle layer during endoscopic submucosal dissection (ESD) in the esophagus can lead to complications such as fever and pain. Although closure with endoscopic clips is widely used when perforation is a major complication, its value when the exposed muscle layer is not perforated is unclear. Data for 104 lesions in 104 patients who underwent esophageal ESD between 2008 and 2020 were retrospectively analyzed. Patients with multiple tumors, those who experienced procedure-related adverse events such as aspiration pneumonitis, perforation during ESD, or delayed bleeding, and those in whom the muscle layer was not exposed were excluded. The clinical course of inflammation after ESD in patients in whom the muscle layer was exposed was examined according to whether endoscopic clips were used for closure. A significantly greater number of patients had a temperature ≤ 37.5°C in the clip closure group than in the nonclip closure group (≤37.5°C/≥37.6°C, 47/14 vs. 25/18, respectively,P= 0.040). Furthermore, significantly more patients in the clip closure group had a white blood cell count ≤10,000/μL (≤10,000/μL/>10,000/μL, 51/10 vs. 21/22,P< 0.001) and a C-reactive protein level < 1.0 mg/dL (<1.0 mg/dL/≥1.0 mg/dL, 40/21 vs. 36/7,P= 0.040) in the 24 hour post-ESD. The results were not changed after propensity score matching. Closure with endoscopic clips reduces inflammation after esophageal ESD with nonperforated muscle layer exposure. Even if there is no obvious perforation during ESD, closure of the exposed muscle layer with endoscopic clips may contribute to the clinical course post-ESD.