Endoscopic band ligation for colonic diverticular bleeding: possibility of standardization.
Endoscopic band ligation for colonic diverticular bleeding: possibility of standardization.
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DOI：
10.1055/s-0041-110954
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发表时间：
2016-02
影响因子：
2.6
通讯作者：
Fujita Y
中科院分区：
文献类型：
--
作者：
Shimamura Y;Ishii N;Omata F;Imamura N;Okamoto T;Ego M;Nakano K;Ikeya T;Nakamura K;Takagi K;Fukuda K;Fujita Y
背景和目的：内镜下套扎术（EBL）已被用于结肠憩室出血患者的止血。EBL由非专业内镜医师进行时的安全性和有效性尚未得到充分验证。本研究旨在阐明EBL技术在由非专业内镜医师进行时的可行性，并将EBL视为结肠憩室出血的标准治疗。 患者和方法：2009年6月至2014年10月期间，在日本东京的一家三级转诊中心进行了一项回顾性队列研究。共有95名接受EBL治疗的患者被纳入研究，并根据他们是否接受过专家或非专家内镜医生的治疗分为两组。评估各组的合并症、药物、休克指数、入院时血红蛋白水平、出血憩室的位置、肠道准备率、手术时间和EBL相关不良事件，采用多变量线性回归分析研究EBL手术时间相关因素，EBL手术时间是指用止血夹标记出血部位和完成带释放之间的时间。 结果：共有47例（49.5%）手术由专家内镜医师进行。 在双变量分析中，专家组和非专家组的EBL手术时间中位数分别为15分钟（范围4 - 45）和11分钟（范围4 - 36）（P = 0.03）。 当使用多元线性回归模型时，右侧憩室的EBL是影响EBL手术时间最显著的因素。未发生不良事件。 结论：EBL可由非专业内镜医师安全有效地进行。右侧憩室位置是影响EBL手术时间的最显著因素。
Background and aims: Endoscopic band ligation (EBL) has been used to achieve hemostasis in patients with colonic diverticular bleeding. The safety and effectiveness of EBL when performed by non-expert endoscopists have not been sufficiently verified. This study aimed to elucidate the feasibility of the EBL technique when performed by non-expert endoscopists and of considering EBL as a standard treatment for colonic diverticular bleeding. Patients and methods: A retrospective cohort study was conducted in a tertiary referral center in Tokyo, Japan, between June 2009 and October 2014. A total of 95 patients treated with EBL were included in the study and were divided into two groups according to whether they had been treated by expert or non-expert endoscopists. Comorbidities, medications, shock index, hemoglobin level on admission, location of the bleeding diverticula, rate of bowel preparation, procedure time, and EBL-associated adverse events were evaluated in each group. Multivariate linear regression analyses were used to investigate factors related to EBL procedure time, which is the time elapsed between marking the site of bleeding with hemoclips and completion of the band release. Results: A total of 47 (49.5 %) procedures were performed by expert endoscopists. In a bivariate analysis, the median EBL procedure times in the expert and non-expert groups were 15 minutes (range 4 – 45) and 11 minutes (range 4 – 36), respectively (P = 0.03). When a multivariate linear regression model was used, EBL for right-sided diverticula was the factor most significantly affecting EBL procedure time. No adverse events were encountered. Conclusion: EBL can be safely and effectively performed by non-expert endoscopists. A right-sided location of diverticula was the factor most significantly affecting EBL procedure time.