目的:内镜下可拆式圈套器结扎(EDSL)治疗结肠憩室出血(CDH)的止血机制与内镜下绑带结扎相似,这是有效和安全的。然而,因为关于EDSL的报告很少,我们进行了一项双中心队列研究以评估其有效性.
方法:本研究分析了2015年7月至2021年11月在两家日本医院接受EDSL治疗的283例CDH患者。回顾性评估患者特征和临床结果。进行Kaplan-Meier分析以评估EDSL后再出血的累积概率。进行Cox比例风险回归分析以比较完全结扎和不完全结扎对再出血的影响。
结果:初次止血成功率和早期再出血率分别为97.9%和11.0%,分别。确定出血部位后的止血时间和总操作时间分别为9分钟和44分钟,分别。32.9%的患者需要输注红细胞。EDSL后住院时间中位数为5天。早期再出血组完全结扎率明显低于未早期再出血组(P<0.01)。EDSL的1年累积再出血率为28.2%。完全结扎与EDSL后累积再出血减少相关(P<0.01)。一名患者经历结肠憩室炎;然而,未观察到结肠穿孔。
结论:完全结扎与短期和长期再出血减少相关。EDSL对CDH可能很有价值,因为它的再出血率低,并且没有严重的不良事件。
OBJECTIVE: The hemostatic mechanism of endoscopic detachable snare ligation (EDSL) for colonic diverticular hemorrhage (CDH) is similar to that of endoscopic band ligation, which is effective and safe. However, because reports on EDSL are scarce, we conducted a two-center cohort study to evaluate its effectiveness.
METHODS: This study analyzed 283 patients with CDH treated with EDSL at two Japanese hospitals between July 2015 and November 2021. Patient characteristics and clinical outcomes were retrospectively evaluated. A Kaplan-Meier analysis was performed to evaluate the cumulative probability of rebleeding after EDSL. A Cox proportional hazards regression analysis was performed to compare the effects of complete and incomplete ligation on rebleeding.
RESULTS: The initial hemostasis success and early rebleeding rates were 97.9% and 11.0%, respectively. The time to hemostasis after identification of the bleeding site and total procedure time were 9 min and 44 min, respectively. Red blood cell transfusion was required for 32.9% of patients. The median hospital length of stay after EDSL was 5 days. The complete ligation rate of the early rebleeding group was significantly lower than that of the group without early rebleeding (P < 0.01). The 1-year cumulative rebleeding rate with EDSL was 28.2%. Complete ligation was associated with decreased cumulative rebleeding after EDSL (P < 0.01). One patient experienced colonic diverticulitis; however, colonic perforation was not observed.
CONCLUSIONS: Complete ligation is associated with reduced short-term and long-term rebleeding. EDSL could be valuable for CDH because of its low rebleeding rate and the absence of serious adverse events.