Prevention of bleeding in the early postoperative period after intraluminal stomach resection: results of a prospective randomized study

Shapovolyants S.G.

Pirogov Russian National Research Medical University

Plakhov R.V.

Pirogov Russian National Research Medical University;
City Clinical Hospital No. 31

Bordikov M.V.

Pirogov Russian National Medical University;
City Clinical Hospital No. 31

Gorbachev E.V.

Pirogov Russian National Medical University;
City Clinical Hospital No. 31

Zhitareva I.V.

Pirogov Russian National Medical University

Fedorov E.D.

Pirogov Russian National Research Medical University of the Russian Ministry of Health

SPIN RSCI: 6785-9959
Scopus AuthorID: 7004381289
ORCID: 0000-0002-6036-7061

Prevention of bleeding in the early postoperative period after intraluminal stomach resection: results of a prospective randomized study

Authors:

Shapovolyants S.G., Plakhov R.V., Bordikov M.V., Gorbachev E.V., Zhitareva I.V., Fedorov E.D.

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Journal: Endoscopic Surgery. 2020;26(5): 5‑15

DOI: 10.17116/endoskop2020260515

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To cite this article:

Shapovolyants SG, Plakhov RV, Bordikov MV, Gorbachev EV, Zhitareva IV, Fedorov ED. Prevention of bleeding in the early postoperative period after intraluminal stomach resection: results of a prospective randomized study. Endoscopic Surgery. 2020;26(5):5‑15. (In Russ.)
https://doi.org/10.17116/endoskop2020260515

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PURPOSE OF THE STUDY

Improving the results of endoscopic intraluminal removal of gastric neoplasms by forming an algorithm for postoperative management of this group of patients.

MATERIAL AND METHODS

From January 01, 2012 to December 31, 2019, 82 (100%) patients (18-85 years old) who underwent endoscopic resection of 87 gastric neoplasms: 72 (82.8%) epithelial and 15 (17.3%) subepithelial formations were included in prospective randomized study. On the 2nd day, a control esophagogastroduodenoscopy (EGDS) was performed, before which all patients were divided into 2 groups: a group of proton pump inhibitors (PPI) — 43 (52.4%) patients, and a PPI + endoscopic clipping (EC) group — 39 (47.6%) patients. The sizes of neoplasms in the PPI group were 21.9±9.9 mm, in the PPI + EC group — 16.6±8.1 mm. In the PPI group, conservative prevention of bleeding was performed, in the PPI + EC group, endoscopic hemostasis was additionally performed according to indications.

RESULTS

45 (54.9%) endoscopic mucosal resections (EMR), 33 (40.2%) submucosal endoscopic dissections (SMED), 3 (3.7%) EMR + SMED and 1 (1.2%) hybrid SMED were performed. The size of the postoperative defect in the PPI group was 24.7±16.5 mm, in the PPI + EC group — 16.6±10.5 mm. Bleeding at the end of the surgery was observed in 7 (8.5%) patients, endoscopic hemostasis was performed in 35 (42.7%) cases. Postoperative bleeding was observed in 7 (8.5%) patients, endoscopic hemostasis was performed in 35 (42.7%) cases. Multiple statistical analysis of the data obtained was carried out. Risk factors for postoperative bleeding: vessels in the postoperative wound bed at the end of the surgery, requiring endoscopic hemostasis, the size of the wound is more than 20 mm, as well as the location of the neoplasm in the distal stomach.

CONCLUSION

A smooth postoperative period was observed in 45 (54.9%) patients, bleeding was reported in 4 (4.9%) cases, which makes it inappropriate to perform EGDS in all patients after endoscopic stomach resection. Risk factors make it possible to determine a group of patients who, along with adequate antisecretory therapy, require control gastroscopy on the 2nd day after the operation and endoscopic hemostasis if indicated.

Keywords:

gastric neoplasm

EMR

SMED

gastrointestinal bleeding

endoscopy

Authors:

Shapovolyants S.G.

Pirogov Russian National Research Medical University

Plakhov R.V.

Pirogov Russian National Research Medical University;
City Clinical Hospital No. 31

Bordikov M.V.

Pirogov Russian National Medical University;
City Clinical Hospital No. 31

Gorbachev E.V.

Pirogov Russian National Medical University;
City Clinical Hospital No. 31

Zhitareva I.V.

Pirogov Russian National Medical University

Fedorov E.D.

Pirogov Russian National Research Medical University of the Russian Ministry of Health

SPIN RSCI: 6785-9959
Scopus AuthorID: 7004381289
ORCID: 0000-0002-6036-7061

Received:

02.07.2020

Accepted:

06.07.2020

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