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.

More about the authors

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

DOI: 10.17116/endoskop2020260515

Read: 3006 times

Download PDF (RU)

Contact the author

Table of contents

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

Использование инфографики авторами научных работ

Close metadata

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

List of references:

Armasheva MV, Klimenko VN, Shcherbakov AM, Tkachenko OB. Endoscopy submucosal dissection — an option in the treatment of early gastric cancer. Vestnik khirurgii. 2017;176(1):25-29. (In Russ.).
Krekoten AA, Agapov MYu, Barsukov AS, Stegniy KV, Eliseytsev MS. Complications of endoscopic resection of gastrointestinal lesions and metods of their correction. Tikhookeanskij meditsinskij zhurnal. 2011;4:17-18. (In Russ.).
Fedorov ED, Plachov RV, Mikhaleva LM, Ivanova EV, Galkova ZV, Buntseva OA. Results of using endoscopic mucosal resection and endoscopic submucosal in patients with superficial epithelial neoplasms of the stomach and duodenum. Eksperimental’naya i klinicheskaya gastroenterologiya. 2011;10:65-72. (In Russ.).
Okada K, Yamamoto Y, Kasuga A. Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc. 2011;25:98-107. https://doi.org/10.1007/s00464-010-1137-4
Goto O, Fujishiro M, Kodashima S. A second-look endoscopy after endoscopic submucosal dissection for gastric epithelial neoplasm may be unnecessary: a retrospective analysis of postendoscopic submucosal dissection bleeding. Gastrointest Endosc. 2010; 71:241-248. https://doi.org/10.1016/j.gie.2009.08.030
Mochizuki S, Uedo N, Oda I. Scheduled second-look endoscopy is not recommended after endoscopic submucosal dissection for gastric neoplasms (the SAFE trial): a multicentre prospective randomised controlled non-inferiority trial. Gut. 2015;64: 397-405.
Miyahara K, Iwakiri R, Shimoda R. Perforation and postoperative bleeding of endoscopic submucosal dissection in gastric tumors: analysis of 1190 lesions in low- and high-volume centers in Saga, Japan. Digestion. 2012;86(3):273-280.
Nam HS, Choi CW. Risk factors for delayed bleeding by onset time after endoscopic submucosal dissection for gastric neoplasm. Sci Rep. 2019;9(1):2674. https://doi.org/10.1038/s41598-019-39381-1
Koh R, Hirasawa K, Yahara S. Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms. Gastrointest Endosc. 2013; 78(3):476-483. https://doi.org/10.1016/j.gie.2013.03.008
Chung IK, Lee JH, Lee SH. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228-1235. https://doi.org/10.1016/j.gie.2008.09.027
Libânio D, Costa MN, Pimentel-Nunes P, Dinis-Ribeiro M. Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis. Gastrointest Endosc. 2016; 84(4):572-586. https://doi.org/10.1016/j.gie.2016.06.033
Higashiyama M, Oka S, Tanaka S. Risk factors for bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm. Dig Endosc. 2011;23(4):290-295. https://doi.org/10.1111/j.1443-1661.2011.01151.x
Takizawa K, Oda I, Gotoda T. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection-an analysis of risk factors. Endoscopy. 2008;40:179-183. https://doi.org/10.1055/s-2007-995530
Akimoto T, Goto O, Sasaki M. «Hold-and-drag» closure technique using repositionable clips for large mucosal defects after colonic endoscopic submucosal dissection. Endosc Int Open. 2016;4:1068-1072.
Yang Z, Wu Q, Liu Z. Proton pump inhibitors versus histamine-2-receptor antagonists for the management of iatrogenic gastric ulcer after endoscopic mucosal resection or endoscopic submucosal dissection: a meta-analysis of randomized trials. Digestion. 2011; 84:315-320.
Kim DS, Jung Y, Rhee HS. Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection. Clin Endosc. 2016;49(3):273-281. https://doi.org/10.5946/ce.2015.086
Jee SR, Park MI, Lim SK. Clinical impact of second-look endoscopy after endoscopic submucosal dissection of gastric neoplasm: a multicenter prospective randomized-controlled trial. Eur J Gastroenterol Hepatol. 2016;28:546-552.
Guo Z, Miao L. Efficacy of second-look endoscopy in preventing delayed bleeding after endoscopic submucosal dissection of early gastric cancer. Exp Ther Med. 2018;16(5):3855-3862. https://doi.org/10.3892/etm.2018.6729.
Mukai S, Cho S, Kotachi T. Analysis of Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Epithelial Neoplasms. Hindawi Publishing Corporation Gastroenterology Research and Practice. 2012; Article ID 875323, 6 pages.
Mukai S, Cho S, Nakamura S. Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD. Surg Endosc. 2013;27:1292-1301.
Ichiro O, Takuji G, Hisanao H. Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Digest Endosc. 2005;17:54-58.

Close metadata