Low-dose PPI to prevent bleeding after ESD: A multicenter randomized controlled study

Yang, Li; Qi, Jian; Chen, Weiqing; Guo, Qinghong; Xie, Rui; Zhao, Zhifeng; Qin, Shanyu; Liu, Aiming; Den, Mingming; Fan, Chaoqiang; Bai, Jianyin; Lin, Hui; Guo, Hong; Yang, Shi‐Ming

doi:10.1016/j.biopha.2021.111251

Cited by 5 publications

(3 citation statements)

References 41 publications

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“…39,46 Medical optimization, such as PPI therapy, may lower the risk of bleeding; however, more data are needed in this area. 47 Other methods, such as applied hemostatic chemicals and polyglycolic acid, may be useful for reducing the risk of delayed bleeding in submucosal procedures. 48 In summary, for intratunnel bleeding, the bleeding sites should be carefully identified and coagulated.…”

Section: Discussionmentioning

confidence: 99%

“…Second‐look endoscopy has been proposed as a means to identify bleeding patients or those with a high risk of delayed bleeding, and whether it could offer benefits requires further study 39,46 . Medical optimization, such as PPI therapy, may lower the risk of bleeding; however, more data are needed in this area 47 . Other methods, such as applied hemostatic chemicals and polyglycolic acid, may be useful for reducing the risk of delayed bleeding in submucosal procedures 48 …”

Section: Discussionmentioning

confidence: 99%

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Management of delayed bleeding of upper gastrointestinal endoscopic submucosal tunneling procedures: a retrospective single‐center analysis and brief meta‐analysis

Wang,

Liu,

Zhang

et al. 2023

J of Gastro and Hepatol

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ObjectivesDelayed bleeding is a rare but important major adverse event (mAE) after endoscopic submucosal tunneling procedures (ESTP), which is scarcely reported. We aimed to characterize the clinical characteristics of delayed bleeding and provide better management of this mAE.MethodFrom August 2010 to October 2022, we reviewed 3852 patients with achalasia receiving peroral endoscopic myotomy (POEM) and 1937 patients with upper gastrointestinal tumors receiving submucosal tunneling endoscopic resection (STER). Among these, records of 22 patients (15 POEM, 7 STER) with delayed bleeding were collected. Clinical characteristics, treatment, and outcomes of delayed bleeding were analyzed.ResultsThe mean age was 43.6 years. Ten patients (45.5%) were intratunnel bleeding, seven (31.8%) were intratunnel bleeding accompanied by mucosal bleeding, and five (22.7%) were mucosal bleeding. The most common accompanied symptoms were hematemesis, fever, and melena. The most common accompanied mAEs were fistula, pulmonary inflammation, and pleural effusion with atelectasis. The mean duration from ESTP to endoscopic intervention was 5.3 ± 4.9 days. Active bleeding was identified in 21 patients (95.5%). The bleeding was successfully controlled by electrocoagulation (19 cases), endoscopic clipping (six cases), and Sengstaken–Blakemore tube insertion (three cases), and no patient required surgical intervention. The mean hemostatic procedure duration was 61.8 ± 45.8 min. The mean post‐bleeding hospital stay was 10.0 ± 6.2 days. A brief meta‐analysis of previous studies showed the pooled estimate delayed bleeding rate after POEM, STER, and G‐POEM was 0.4%.ConclusionsDelayed bleeding is uncommon and could be effectively managed by timely emergency endoscopic procedures without requiring subsequent surgical interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of delayed bleeding of upper gastrointestinal endoscopic submucosal tunneling procedures: a retrospective single‐center analysis and brief meta‐analysis

Wang,

Liu,

Zhang

et al. 2023

J of Gastro and Hepatol

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“…Post-ESD bleeding was the primary observational goal of the study. Based on previous reports [ 7 , 29 , 30 ], post-ESD bleeding was defined as EGD performance based on findings suggestive of bleeding within 4 weeks of ESD. Findings suggestive of bleeding included the appearance of melena or hematemesis, with a decrease in the hemoglobin level by >2 g/dL.…”

Section: Methodsmentioning

confidence: 99%

Modified BEST-J Score Model Predicts Bleeding after Endoscopic Submucosal Dissection with Fewer Factors

Okada

Mikamo

Hamamoto

et al. 2022

Cancers

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This study constructed a simplified post-endoscopic submucosal dissection (ESD) prediction model with a prognostic nutritional index (PNI). A total of 449 patients who underwent gastric ESD was included, divided with a ratio of 2:1, and assigned to the model or validation cohort. A prediction model of post-ESD (modified BEST-J score) was constructed using the model cohort. The modified BEST-J score was evaluated by comparing its accuracy to the BEST-J score in the validation cohort. Within 4 weeks of ESD, melena, hematemesis, or a 2 g/dL or greater decrease in hemoglobin level that required esophagogastroduodenoscopy was defined as post-ESD bleeding. In the model cohort, 299 patients were enrolled and 25 (8.4%) had post-ESD bleeding. Independent risk factors for post-ESD bleeding were use of P2Y12RA, tumor size > 30 mm, location of lesion at lower one-third of the stomach, and PNI ≤ 47.9. Constructing the modified BEST-J score based on these variables, the sensitivity, specificity, and positive likelihood ratio were 73.9%, 78.1%, and 3.37. When comparing the modified BEST-J score to the BEST-J score in the validation cohort, no significant difference was observed by ROC-AUC (0.77 vs. 0.75, p = 0.81). Modified BEST-J score can predict post-ESD bleeding more simply, with the same accuracy as the BEST-J score.

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Management of Adverse Events of Submucosal Endoscopy

Venkat

Visrodia

2023

Gastrointestinal Endoscopy Clinics of North America

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Low-dose PPI to prevent bleeding after ESD: A multicenter randomized controlled study

Cited by 5 publications

References 41 publications

Management of delayed bleeding of upper gastrointestinal endoscopic submucosal tunneling procedures: a retrospective single‐center analysis and brief meta‐analysis

Management of delayed bleeding of upper gastrointestinal endoscopic submucosal tunneling procedures: a retrospective single‐center analysis and brief meta‐analysis

Modified BEST-J Score Model Predicts Bleeding after Endoscopic Submucosal Dissection with Fewer Factors

Management of Adverse Events of Submucosal Endoscopy

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