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Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD

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Abstract

Background

The incidence of delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms is reported to be approximately 5 %. We examined whether postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method is a useful measure for preventing delayed bleeding after ESD.

Methods

A total of 234 gastric epithelial neoplasms were treated from June 2007 to May 2012. Post-ESD coagulation (PEC) and clipping for part of the vessels was performed for 154 lesions from June 2007 to June 2010. A total of 80 lesions were treated using the 2C method from July 2010 to May 2012. During ESD, the locations of the arteries were recorded on a schematic diagram of the lesion. Arteries were defined as regions of arterial bleeding that required coagulation or apparent arteries in which preventive coagulation was performed. When ESD was completed, soft coagulation was performed for arteries in the resection area using hemostatic forceps, followed by arterial clipping for additional strength. Coagulation also was performed continuously for visible vessels in the resection area. This was a retrospective study. The incidence rates of delayed bleeding after ESD, as evidenced by hematemesis or melena, or the presence of anemia (decline in Hb >2 g/dl) that required emergency endoscopy were recorded.

Results

Delayed bleeding occurred in 7 (4.5 %) of the 154 cases treated using PEC and in 1 (1.3 %) of the 80 cases treated using the 2C method. The mean time required for the 2C method was 15.0 ± 7.0 min (range, 5–44 min). The mean number of clippings per lesion was 3.8 ± 2.8 (range, 0–13). Almost all clips fell off within 2 months of the procedure.

Conclusions

Coagulation plus artery-selective clipping (the 2C method) of post-ESD ulcers might effectively reduce the incidence of delayed bleeding after ESD for gastric neoplasms.

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References

  1. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  PubMed  CAS  Google Scholar 

  2. Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942

    Article  PubMed  Google Scholar 

  3. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883

    Article  PubMed  Google Scholar 

  4. Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, Saito D, Ono H (2008) Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection—an analysis of risk factors. Endoscopy 40:179–183

    Article  PubMed  CAS  Google Scholar 

  5. Goto O, Fujishiro M, Kodashima S, Ono S, Niimi K, Hirano K, Yamamichi N, Koike K (2010) 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 71:241–248

    Article  PubMed  Google Scholar 

  6. Tsuji Y, Ohata K, Sekiguchi M, Ito T, Chiba H, Gunji T, Yamamichi N, Fujishiro M, Matsuhashi N, Koike K (2011) An effective training system for endoscopic submucosal dissection of gastric neoplasm. Endoscopy 43:1033–1038

    Article  PubMed  CAS  Google Scholar 

  7. Higashiyama M, Oka S, Tanaka S, Sanomura Y, Imagawa H, Shishido T, Yoshida S, Chayama K (2011) Risk factors for bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm. Dig Endosc 23:290–295

    Article  PubMed  Google Scholar 

  8. Goto O, Fujishiro M, Oda I, Kakushima N, Yamamoto Y, Tsuji Y, Ohata K, Fujiwara T, Fujiwara J, Ishii N, Yokoi C, Miyamoto S, Itoh T, Morishita S, Gotoda T, Koike K (2012) A multicenter survey of the management after gastric endoscopic submucosal dissection related to postoperative bleeding. Dig Dis Sci 57:435–439

    Article  PubMed  Google Scholar 

  9. Toyokawa T, Inaba T, Omote S, Okamoto A, Miyasaka R, Watanabe K, Izumikawa K, Horii J, Fujita I, Ishikawa S, Morikawa T, Murakami T, Tomoda J (2012) Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions. J Gastroenterol Hepatol 27:907–912

    Article  PubMed  Google Scholar 

  10. Muraki Y, Enomoto S, Iguchi M, Fujishiro M, Yahagi N, Ichinose M (2012) Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection. World J Gastrointest Endosc 4:1–8

    Article  PubMed  Google Scholar 

  11. Uedo N, Takeuchi Y, Ishihara R, Hanaoka N, Inoue T, Kizu T, Higashino K, Ishii H, Tatsuta M, Chak A, Wong RCK (2010) Endoscopic Doppler US for the prevention of ulcer bleeding after endoscopic submucosal dissection for early gastric cancer: a preliminary study (with video). Gastrointest Endosc 72:444–448

    Article  PubMed  Google Scholar 

  12. Fujishiro M, Abe N, Endo M, Kawahara Y, Shimoda R, Nagata S, Homma K, Morita Y, Uedo N (2010) Retrospective multicenter study concerning electrocautery forceps with soft coagulation for nonmalignant gastroduodenal ulcer bleeding in Japan. Dig Endosc 22:15–18

    Article  Google Scholar 

  13. Nagata S, Kimura S, Ogoshi H, Hidaka T (2010) Endoscopic hemostasis of gastric ulcer bleeding by hemostatic forceps coagulation. Dig Endosc 22:22–25

    Article  Google Scholar 

  14. Arima S, Sakata Y, Ogata S, Tominaga N, Tsuruoka N, Mannen K, Shiraishi R, Shimoda R, Tsunada S, Sakata H, Iwakiri R, Fujimoto K (2010) Evaluation of hemostasis with soft coagulation using endoscopic hemostatic forceps in comparison with metallic hemoclips for bleeding gastric ulcers: a prospective, randomized trial. J Gastroenterol 45:501–505

    Article  PubMed  Google Scholar 

  15. Joseph JYS, Kelvin KFT, Larry HL, Justin CYW, James YWL (2007) Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 56:1364–1372

    Article  Google Scholar 

  16. Geboes K, Geboes KP, Maleux G (2001) Vascular anatomy of the gastrointestinal tract. Best Pract Res Clin Gastroenterol 15:1–14

    Article  PubMed  CAS  Google Scholar 

  17. Hiramatu K, Kouda E, Mouri M, Isobe Y (1982) X-ray anatomy of the abdominal vascular system. Igaku-Shoin, Tokyo, pp 122–136 In Japanese

    Google Scholar 

  18. Tsuji Y, Ohata K, Ito T, Chiba H, Ohya T, Gunji T, Matsubayashi N (2010) Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions. World J Gastroenterol 16:2913–2917

    Article  PubMed  Google Scholar 

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Disclosure

Drs. Shinichi Mukai, Songde Cho, Shinya Nakamura, Yu Hatano, Takahiro Kotachi, Akinori Shimizu, Genta Matsuura, Takahiro Azakami, Atsuhisa Takaba, Toshihide Hamada, Ken Hirata, and Toshio Nakanishi have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology, Miyoshi Central Hospital, 531 Higashisakeya-chou, Miyoshi, Hiroshima, 728-8502, Japan

    Shinichi Mukai, Songde Cho, Shinya Nakamura, Takahiro Kotachi, Genta Matsuura, Takahiro Azakami, Atsuhisa Takaba, Toshihide Hamada, Ken Hirata & Toshio Nakanishi

  2. Department of Internal Medicine, Mitsugi General Hospital, 124 Ichi, Mitsugi-chou, Onomichi, Hiroshima, 722-0393, Japan

    Yu Hatano

  3. Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Akinori Shimizu

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  1. Shinichi Mukai
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  2. Songde Cho
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  3. Shinya Nakamura
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  4. Yu Hatano
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  5. Takahiro Kotachi
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  6. Akinori Shimizu
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  7. Genta Matsuura
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  8. Takahiro Azakami
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  9. Atsuhisa Takaba
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  10. Toshihide Hamada
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  11. Ken Hirata
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  12. Toshio Nakanishi
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Correspondence to Shinichi Mukai.

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Mukai, S., Cho, S., Nakamura, S. et al. Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD. Surg Endosc 27, 1292–1301 (2013). https://doi.org/10.1007/s00464-012-2600-1

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  • DOI: https://doi.org/10.1007/s00464-012-2600-1

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