Risk-stratified evaluation of prophylactic strategies for delayed bleeding after gastric ESD: a multicenter retrospective study on clipping efficacy in the low-risk category.

IF 1.2 4区医学 Q4 GASTROENTEROLOGY & HEPATOLOGY

Acta gastro-enterologica Belgica Pub Date : 2026-04-01 DOI:10.51821/89.2.15369

S Abiko, K Kinoshita, H Oda, K Hatanaka, Y Yamamoto, H Naruse, T Miyagishima, N Sakamoto

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引用次数: 0

Abstract

Background and study aims: Delayed bleeding (DB) remains a major complication after gastric endoscopic submucosal dissection (ESD), and risk-stratified preventive strategies are not well established. This study evaluated the efficacy of the modified search, coagulation, and clipping (MSCC) method and MSCC combined with polyglycolic acid sheets and fibrin glue (PMSCC) using the Bleeding after ESD Trend from Japan (BEST-J) score.

Patients and methods: We retrospectively analyzed 303 patients who underwent gastric ESD with MSCC or PMSCC between April 2018 and March 2024. DB was defined as bleeding requiring emergency endoscopic hemostasis or transfusion, or a hemoglobin decrease ≥ 2 g/dL. Observed DB rates were compared with threshold rates derived from the BEST-J score.

Results: In the low-risk category (MSCC/PMSCC: 237/0), no DB occurred in the MSCC group (0%; 95% confidence interval [CI]: 0.00-1.54%), with the upper CI limit below the threshold rate (2.8%). In the intermediate-risk category, DB occurred in one patient in the MSCC group (1/29; 3.4%; 95% CI: 0.08-17.8%), and no DB was observed in the PMSCC group (0/3; 0.0%; 95% CI: 0.00-70.8%); the confidence intervals overlapped the threshold rate (6.1%). In the high-risk category, DB occurred in 1/4 (25.0%; 95% CI: 0.63-80.6%) and 5/30 (16.7%; 95% CI: 5.6-34.7%) patients in the MSCC and PMSCC groups, respectively; neither the observed rate nor its confidence interval fell below the threshold rate (11.4%).

Conclusions: The MSCC method is an effective prophylactic strategy for preventing DB in the low-risk category as defined by the BEST-J score.

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胃ESD后迟发性出血预防策略的风险分层评价：一项低风险类别的多中心回顾性研究。

背景与研究目的：胃内镜下粘膜下剥离（ESD）术后，延迟性出血（DB）仍是其主要并发症之一，风险分层预防策略尚未建立。本研究使用日本BEST-J评分评估改良搜索、凝血和夹夹（MSCC）方法和MSCC联合聚乙醇酸片和纤维蛋白胶（PMSCC）的疗效。患者和方法：我们回顾性分析了2018年4月至2024年3月期间303例伴有MSCC或PMSCC的胃ESD患者。DB定义为出血需要急诊内镜止血或输血，或血红蛋白降低≥2 g/dL。将观察到的DB率与BEST-J评分得出的阈值率进行比较。结果：低危组（MSCC/PMSCC: 237/0）， MSCC组无DB发生（0%；95%置信区间[CI]: 0.00-1.54%）， CI上限低于阈值率（2.8%）。在中危组中，MSCC组中有1例患者发生DB (1/29; 3.4%; 95% CI: 0.08-17.8%)， PMSCC组中无DB (0/3; 0.0%; 95% CI: 0.00-70.8%)；置信区间与阈值率重叠（6.1%）。高危组中，MSCC组和PMSCC组分别有1/4 （25.0%,95% CI: 0.63-80.6%）和5/30 （16.7%,95% CI: 5.6-34.7%）患者发生DB；观测率及其置信区间均未低于阈值率（11.4%）。结论：MSCC方法是一种有效的预防策略，可以预防由BEST-J评分定义的低风险类别的DB。

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来源期刊

Acta gastro-enterologica Belgica Medicine-Gastroenterology

CiteScore

2.30

自引率

20.00%

发文量

期刊介绍： The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.