Delayed bleeding after endoscopic submucosal dissection for non-ampullary superficial duodenal neoplasias might be prevented by prophylactic endoscopic closure: Analysis of risk factors
Delayed bleeding after endoscopic submucosal dissection for non-ampullary superficial duodenal neoplasias might be prevented by prophylactic endoscopic closure: Analysis of risk factors
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DOI：
10.1111/den.12377
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发表时间：
2015-03-01
影响因子：
5.3
通讯作者：
Yahagi, Naohisa
中科院分区：
文献类型：
--
作者：
Hoteya, Shu;Kaise, Mitsuru;Yahagi, Naohisa
背景和目的：十二指肠内镜下粘膜下剥离术（ESD）由于解剖结构的特殊性而在技术上具有挑战性，迄今为止，尚未就穿孔和迟发性出血等并发症的高发生率进行验证。在本研究中，十二指肠ESD后迟发性出血的危险因素，提出了建立预防措施的目标。方法：我们分析了63例非壶腹浅表性十二指肠肿瘤治疗ESD从2005年4月至2014年3月。为了分析十二指肠ESD后迟发性出血的危险因素，我们将患者分为迟发性出血组和非出血组。为了验证十二指肠ESD后迟发性出血的危险因素，我们分析了各种患者，病变，和治疗相关factors.Results：迟发性出血是经历了11例（17.5%）患者相关的迟发性出血的危险因素的单变量分析表明没有显着的危险因素。病变相关和治疗相关风险因素的单变量分析表明，只有内镜闭合是一个重要的风险因素。多变量分析还发现内镜闭合（未闭合>闭合：P = 0.049）是与十二指肠ESD后迟发性出血显著相关的独立因素。高血压（目前>无：P = 0.055）显示了一个非显着的趋势的关联多变量analysis.Conclusions：这项回顾性评价发现，内镜关闭与十二指肠ESD后迟发性出血的风险降低。十二指肠ESD后迟发性出血可通过预防性内镜闭合来预防。
Background and Aim: Duodenal endoscopic submucosal dissection (ESD) is technically challenging because of anatomical specificities and, to date, has not been validated concerning the high rate of complications such as perforation and delayed bleeding. In the present study, the risk factors for delayed bleeding after duodenal ESD are presented with the goal of establishing preventive measures.Methods: We analyzed 63 patients with non-ampullary superficial duodenal neoplasias treated by ESD from April 2005 to March 2014. To analyze the risk factors of delayed bleeding after duodenal ESD, we divided the patients into a delayed bleeding group and a non-bleeding group. To verify the risk factors of delayed bleeding after duodenal ESD, we analyzed various patient-, lesion-, and treatment-related factors.Results: Delayed bleeding was experienced in 11 patients (17.5%) Univariate analysis of patient-related risk factors of delayed bleeding indicated no significant risk factor. Univariate analysis of lesion-related and treatment-related risk factors indicated only endoscopic closure as a significant risk factor. Multivariate analysis also identified endoscopic closure (not done > done: P = 0.049) as an independent factor significantly associated with delayed bleeding after duodenal ESD. Hypertension (present > absent: P = 0.055) showed a non-significant tendency of association by multivariate analysis.Conclusions: This retrospective evaluation found that endoscopic closure was associated with a reduced risk of delayed bleeding after duodenal ESD. Delayed bleeding after duodenal ESD might be prevented by prophylactic endoscopic closure.