A pilot study using an infrared imaging system in prevention of post-endoscopic submucosal dissection ulcer bleeding

Yoshida, Yukinaga; Matsuda, Koji; Tamai, Naoto; Yoshizawa, Kai; Nikami, Toshiki; Ishiguro, Haruya; Tajiri, Hisao

doi:10.1007/s10120-013-0231-4

Cited by 3 publications

(4 citation statements)

References 21 publications

(22 reference statements)

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“…In addition to ensuring these measures, we believe that some additional measures would be required in patients with large resected specimens or lesions in the L segment and younger patients, who were found in this study to be more prone to postoperative bleeding. For example, it is necessary to identify blood vessels at the ulcer base after ESD, that are prone to cause postoperative bleeding, using endoscopic Doppler ultrasound or infrared imaging system [ 33 , 34 ], and to use over-the-scope-clip for cerclage of the ESD ulcer and medical adhesives for covering the ulcer [ 35 , 36 ]. As these devices and drugs have been examined in only a small number of patients, further study is desired.…”

Section: Discussionmentioning

confidence: 99%

A second-look endoscopy may not reduce the bleeding after endoscopic submucosal dissection for gastric epithelial neoplasm

et al. 2014

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BackgroundGastric endoscopic submucosal dissection (ESD) has gradually come to be recommended as the optimal treatment for early gastric cancer; however, one of the primary issues is postoperative bleeding. Although second-look endoscopy is conventionally performed to reduce the risk of postoperative bleeding, its benefit has not yet been clearly elucidated. The objective of this study was to elucidate the benefit of second-look endoscopy.MethodsA total of 459 lesions in patients were underwent gastric ESD from May 2004 to April 2013 at our hospital were included in the analysis. The patients were divided into those who had bleeding within 24 hours after ESD (immediate bleeding) and those in whom bleeding occurred 24 hours or more after the procedure (delayed bleeding); the underlying disease, age, lesion site, diameter of the resected specimen, and lesion diameter were analyzed to identify the risk factors for postoperative bleeding after ESD.ResultsPost-ESD immediate or delayed bleeding occurred in 23 of the 459 cases (5.0%). Second-look endoscopy was performed in 210 of 447 cases (47.0%) excluding 12 cases with immediate bleeding; in the remaining 237 of the 447 cases (53.0%), it was not performed. Post-ESD delayed bleeding occurred in 6 of the 210 cases (2.9%) and 5 of the 237 cases (2.1%), with no statistically significant difference between the two groups. Overall, the following factors were identified as the risk factors for postoperative bleeding: young age (P = 0.005), lesions in the L segment (P = 0.042), and large size of the resected specimen (P = 0.005). The risk factors identified in the immediate bleeding group were lesions in the L segment (P = 0.032), large size of the resected specimen (P < 0.001), and large tumor size (P = 0.011), and those in the delayed bleeding group were young age (P = 0.013) and concomitant renal disease (P = 0.011).ConclusionsThe results of this study suggest that second-look endoscopy after gastric ESD may not be useful for preventing postoperative bleeding.

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Section: Discussionmentioning

confidence: 99%

A second-look endoscopy may not reduce the bleeding after endoscopic submucosal dissection for gastric epithelial neoplasm

et al. 2014

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“…Some investigators, therefore, have developed methods to try to identify vessels that have a low risk of bleeding. One method uses infrared imaging 49. Yoshida et al49 classified nonbleeding visible vessels a blue or gray points using this system and water-jet pressure was applied to an artificial ulcer base to induce iatrogenic bleeding.…”

Section: Preventing Esd-related Bleedingmentioning

confidence: 99%

“…One method uses infrared imaging 49. Yoshida et al49 classified nonbleeding visible vessels a blue or gray points using this system and water-jet pressure was applied to an artificial ulcer base to induce iatrogenic bleeding. Vessels with blood flow were dark gray from infrared absorption by hemoglobin; coagulated vessels were blue.…”

Section: Preventing Esd-related Bleedingmentioning

confidence: 99%

Preventing and Controlling Bleeding in Gastric Endoscopic Submucosal Dissection

Park

Lee

2013

Clin Endosc

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Although techniques and instruments for endoscopic submucosal dissection (ESD) have improved, bleeding is still the most common complication. Minimizing the occurrence of bleeding is important because blood can interfere with subsequent procedures. Generally, ESD-related bleeding can be divided into intraprocedural and postprocedural bleedings. Postprocedural bleeding can be further classified into early post-ESD bleeding which occurs within 48 hours after ESD and late post-ESD bleeding which occurs later than 48 hours after ESD. A basic principle for avoiding intraprocedural bleeding is to watch for vessels and coagulate them before cutting. Several countertraction devices have been designed to minimize intraprocedural bleeding. Methods for reducing postprocedural bleeding include administration of proton-pump inhibitors or prophylactic coagulation after ESD. Medical adhesive spray such as n-butyl-2-cyanoacrylate is also an option for preventing postprocedural bleeding. Various endoscopic treatment modalities are used for both intraprocedural and postprocedural bleeding. However, hemoclipping is infrequently used during ESD because the clips interfere with subsequent resection. Bleeding that occurs as a result of ESD can usually be managed easily. Nonetheless, more effective ways to prevent bleeding, including reliable ESD techniques, must be developed.

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“…A different approach to lessen post-ESD bleeding was taken by Yoshida et al [17] to detect the nonbleeding visible vessels effectively by use of an infrared imaging system. They revealed that blue points did not need coagulation and gray points had a potential risk of bleeding and needed preventative hemostasis.…”

Section: Complications and Their Preventionmentioning

confidence: 99%

Updated evidence on endoscopic resection of early gastric cancer from Japan

et al. 2016

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A pilot study using an infrared imaging system in prevention of post-endoscopic submucosal dissection ulcer bleeding

Abstract: The IRI system detects visible vessels (VVs) that are in no need of coagulation as blue points, and VVs have a potential risk of bleeding as gray points.

Cited by 3 publications

References 21 publications

A second-look endoscopy may not reduce the bleeding after endoscopic submucosal dissection for gastric epithelial neoplasm

A second-look endoscopy may not reduce the bleeding after endoscopic submucosal dissection for gastric epithelial neoplasm

Preventing and Controlling Bleeding in Gastric Endoscopic Submucosal Dissection

Updated evidence on endoscopic resection of early gastric cancer from Japan

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