A pilot study using an infrared imaging system in prevention of post-endoscopic submucosal dissection ulcer bleeding
Tóm tắt
Endoscopic submucosal dissection (ESD) for superficial gastric neoplasm is a curative method. The aim of this study was to detect potential nonbleeding visible vessels (NBVVs) by using an infrared imaging (IRI) system. A total of 24 patients (25 lesions) were consecutively enrolled between March 2010 and December 2010. The day after ESD, endoscopist A (K.M.), who was blinded to the actual procedure of ESD, performed esophagogastroduodenoscopy (EGD) of the post-ESD ulcer base using the IRI system. Endoscopist A marked gray/blue points in the hard-copy images with the IRI system. After the first procedure, endoscopist B (Y.Y.), who was blinded to the results recorded by endoscopist A, performed a second EGD with white light endoscopy and administered water-jet pressure with the maximum level of an Olympus flushing pump onto the post-ESD ulcer base. This test can cause iatrogenic bleeding via application of pressure to NBVV in the post-ESD ulcer. The IRI system detected 58 gray points and 71 blue points. The post-ESD ulcer was divided into the central area and the peripheral area. There were 14 gray points (24 %) in the central area and 44 gray points (76 %) in the peripheral area. There were 19 blue points (27 %) in the central area and 52 blue points (73 %) in the peripheral area. There was no significant difference when comparing the distribution of gray points and blue points. Bleeding occurred with a water-jet pressure in 11 of 58 gray points and in none of the blue points (P = 0.000478). Among the gray points, bleeding in response to a water-jet pressure occurred in 2 points in the central area and in 9 points in the peripheral area. 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.
Tài liệu tham khảo
Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006;41:929–42.
Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228–35.
Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M, Costa N, Lopes C, Moreira-Dias L. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc. 2009;69:350–5.
Neuhaus H. Endoscopic submucosal dissection in the upper gastrointestinal tract: present and future view of Europe. Dig Endosc. 2009;21(suppl 1):S4–6.
Othman MO, Wallace MB. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in 2011, a Western perspective. Clin Res Hepatol Gastroenterol. 2011;35:286–94.
Probst A, Pommer B, Golger D, Anthuber M, Arnholdt H, Messmann H. Endoscopic submucosal dissection in gastric neoplasia: experience from a European center. Endoscopy. 2010;42:1037–44.
Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10:1–11.
Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, et al. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection: an analysis of risk factors. Endoscopy. 2008;40:179–83.
Narimiya N, Isshi K, Nakamura Y, Tajiri H. Observation on infrared image of mucosal defects caused by endoscopic mucosal resection using electronic endoscopy. Gastroenterol Endosc. 2005;47:2361–70.
Nakayoshi T, Tamai N, Matsuda K, Tajiri H. The infrared ray imaging (IRI) system may predict delayed-type bleeding from the mucosal defect after EMR or ESD for the gastric tumors. Gastrointest Endosc. 2007;65(5):AB351.
Gostout CJ, Jacques SL. Infrared video imaging of subsurface vessels: a feasibility study for the endoscopic management of gastrointestinal bleeding. Gastrointest Endosc. 1995;41:218–24.
Hayashi N, Kawano S, Tsuji S, Tsujii M, Takai Y, Nagano K, et al. Identification and diameter assessment of gastric submucosal vessels using infrared electronic endoscopy. Endoscopy. 1994;26:686–9.
Mataki N, Nagao S, Kawaguchi A, Matsuzaki K, Miyazaki J, Kitagawa Y, et al. Clinical usefulness of a new infrared videoendoscope system for diagnosis of early stage gastric cancer. Gastrointest Endosc. 2003;57:336–42.
Huang Y, Kakushima N, Takizawa K, Tanaka M, Ikehara H, Yamaguchi Y, et al. Risk factors for recurrence of artificial gastric ulcers after endoscopic submucosal dissection. Endoscopy. 2011;43:236–9.
Jang JS, Choi SR, Graham DY, Kwon HC, Kim MC, Jeong JS, et al. Risk factors for immediate and delayed bleeding associated with endoscopic submucosal dissection of gastric neoplastic lesions. Scand J Gastroenterol. 2009;25:1–7.
Mannen K, Tsunada S, Hara M, Yamaguchi K, Sakata Y, Fujise T, et al. Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions. J Gastroenterol. 2010;45:30–6.
Matsushita M, Mori S, Tahashi Y, Uchida K, Nishio A, Okazaki K. The site of delayed bleeding suggests the cause of bleeding after endoscopic submucosal dissection. Scand J Gastroenterol. 2010;45:1127–8.
Matsushita M, Mori S, Tahashi Y, Uchida K, Nishio A, Okazaki K. Immediate bleeding during endoscopic submucosal dissection: a predictor of delayed bleeding? Gastrointest Endosc. 2011;73:413–4.
Cipolletta L, Bianco MA, Salerno R, Prisco A, Marmo R, Cipolletta F, et al. Improved characterization of visible vessels in bleeding ulcers by using magnification endoscopy: results of a pilot study. Gastrointest Endosc. 2010;72:413–8.
Uedo N, Takeuchi Y, Ishihara R, Hanaoka N, Inoue T, Kizu T, et al. Endoscopic Doppler US for the prevention of ulcer bleeding after endoscopic submucosal dissection for early gastric cancer: a preliminary study (with video). Gastrointest Endosc. 2010;72:444–8.
Tamai N, Matsuda K, Sumiyama K, Isshi K, Narimiya N, Tajiri H, et al. Prophylactic hemostasis for postpolypectomy mucosal defect using endoclip under infrared imaging endoscopy. Surg Technol Int. 2010;19:91–6.
Lin HJ, Perng CL, Lee FY, Lee CH, Lee SD. Clinical courses and predictors for rebleeding in patients with peptic ulcers and non-bleeding visible vessels: a prospective study. Gut. 1994;35:1389–93.
Amano Y, Moriyama N, Suetsugu H, Ishimura N, Imaoka T, Komazawa Y. Which types of non-bleeding visible vessels in gastric peptic ulcers should be treated by endoscopic hemostasis? J Gastroenterol Hepatol. 2004;19:13–7.