Dialysis, Antithrombotics, and Lesion Location: Who Benefits Most from Gel Immersion Endoscopy in Gastric Endoscopic Submucosal Dissection?

IF 3.6 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Digestion Pub Date : 2025-08-16 DOI:10.1159/000548018
Hiroki Hayashi, Takeshi Kanno, Tomonori Yano, Kazuaki Akahoshi, Jun Owada, Hiromi Sekiguchi, Takashi Ueno, Yoshie Nomoto, Hisashi Fukuda, Haruo Takahashi, Yuji Ino, Hironori Yamamoto
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引用次数: 0

Abstract

Introduction: Gel immersion endoscopy (GIE) is a technique used to maintain a clear view during gastric endoscopic submucosal dissection. We aimed to identify cases most likely to benefit from GIE for ESD bleeding by reviewing our clinical experience and determining the associated factors.

Methods: We retrospectively analyzed 470 lesions in 380 patients who underwent gastric ESD between October 2020 and March 2023. The patients were divided into conventional method (n = 433) and GIE groups (n = 37). We compared the clinical and pathological characteristics between the groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with GIE use. Among the GIE group, hemostasis times under gas, water, and gel conditions were compared using the Kruskal-Wallis test.

Results: Multivariate analysis revealed that dialysis (odds ratio [OR]: 15.3), concurrent antiplatelet and anticoagulant use (OR: 9.5), and tumor location in the middle third (OR: 3.5), upper third (OR: 5.7), or remnant stomach (OR: 9.3) were independently associated with GIE use. No significant differences in overall hemostasis time were observed between gas, water, or gel. Of the nine bleeding events exceeding 300 s under gas immersion, seven achieved successful hemostasis by switching to GIE, with a median of 32 s to locate the source and 140 s to complete hemostasis.

Conclusion: Dialysis, combined antithrombotic use, and certain tumor locations were key factors influencing GIE for ESD bleeding. Although the overall hemostasis times did not differ, GIE may be particularly beneficial in high-risk scenarios.

透析、抗血栓和病变定位:在胃镜粘膜下解剖中,谁从凝胶浸泡内镜中获益最多?
凝胶浸泡内镜(GIE)是一种在胃镜粘膜下剥离(ESD)过程中保持清晰视野的技术。我们的目的是通过回顾我们的临床经验和确定相关因素来确定最有可能从ESD出血的GIE中获益的病例。方法:我们回顾性分析了2020年10月至2023年3月期间接受胃ESD治疗的380例患者的470个病变。将患者分为常规方法组(CM组,n=433)和GIE组(n=37)。比较两组患者的临床及病理特点。单因素和多因素logistic回归分析用于确定与GIE使用相关的因素。采用Kruskal-Wallis试验比较GIE组在气体、水和凝胶条件下的止血时间。结果:多因素分析显示,透析(比值比[OR]: 15.3)、同时使用抗血小板和抗凝剂(OR: 9.5)、肿瘤位置在中间三分之一(OR: 3.5)、上三分之一(OR: 5.7)或残胃(OR: 9.3)与GIE使用独立相关。气体、水或凝胶在总止血时间上无显著差异。在9例气体浸泡下超过300秒的出血事件中,7例通过切换到GIE成功止血,平均32秒定位出血源,140秒完全止血。结论:透析、联合使用抗栓药物和肿瘤部位是影响ESD出血GIE的关键因素。虽然总体止血时间没有差异,但在高危情况下,GIE可能特别有益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Digestion
Digestion 医学-胃肠肝病学
CiteScore
7.90
自引率
0.00%
发文量
39
审稿时长
6-12 weeks
期刊介绍: ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.
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