Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal tumors.The rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that f...Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal tumors.The rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that for esophagus,duodenum and colon cancer(around 2%-4%).Although investigations into the risk factors for post-ESD bleeding have identified several procedure-,lesion-,physician-and patient-related factors,use of antithrombotic drugs,especially anticoagulants[direct oral anticoagulants(DOACs)and warfarin],is thought to be the biggest risk factor for post-ESD bleeding.In fact,the post-ESD bleeding rate in patients receiving DOACs is 8.7%-20.8%,which is higher than that in patients not receiving anticoagulants.However,because clinical guidelines for management of ESD in patients receiving DOACs differ among countries,it is necessary for endoscopists to identify ways to prevent post-ESD delayed bleeding in clinical practice.Given that the pharmacokinetics(e.g.,plasma DOAC level at both trough and T_(max))and pharmacodynamics(e.g.,anti-factor Xa activity)of DOACs are related to risk of major bleeding,plasma DOAC level and anti-FXa activity may be useful parameters for monitoring the anti-coagulate effect and identifying DOAC patients at higher risk of post-ESD bleeding.展开更多
BACKGROUND Postoperative delayed bleeding(PDB) after gastric endoscopic submucosal dissection(ESD) is the most common adverse event in patients receiving antithrombotics even with second-look endoscopy. Moreover, with...BACKGROUND Postoperative delayed bleeding(PDB) after gastric endoscopic submucosal dissection(ESD) is the most common adverse event in patients receiving antithrombotics even with second-look endoscopy. Moreover, with the increasing prevalence of cardiovascular and cerebrovascular diseases in an aging population with associated lifestyle-related diseases, an increasing number of patients receive antithrombotics. Several attempts have been made to prevent PDB in aging population;however, a consensus has yet to be reached.AIM To examine the efficacy of third-look endoscopy(TLE) for PDB prevention.METHODS One hundred patients with early gastric neoplasms receiving antithrombotics were prospectively enrolled and subjected to ESD with TLE between February 2017 and July 2019. The primary endpoint was PDB rate, which was compared with our preset threshold. Furthermore, we divided the bleeding period into early-and late-onset PDB(E-PDB and L-PDB, respectively) and analyzed its rate. As a secondary analysis, we compared PDB rates with those of a historical control group, using propensity score matching, and calculated the PDB rates per antithrombotic agent use in each group.RESULTS In total, 96 patients and 114 specimens were finally evaluated. The overall PDB rate was 7.9%(9/114) [90%CI: 4.7-13.1, P = 0.005], while the late-and early-onset PDB rates(L-PDB and E-PDB) were 5.3% [90%CI: 2.7-9.9, P < 0.0001] and 2.6% [90%CI: 1.1-6.4, P = 0.51], respectively. Propensity score matching generated 58 matched pairs for TLE and control groups. No differences were found in overall PDB incidence(10.3% vs 20.7%, P = 0.12), whereas L-PDB occurrence significantly differed(5.2% vs 17.2%, P = 0.04) between groups. Considering antithrombotics' use, the overall PDB rate was higher for direct oral anticoagulants and multiple antithrombotics in the control group, while L-PDB incidence was lower in the TLE group for these agents(8.7% vs 23.1% and 5.0% vs 29.4%, respectively).CONCLUSION TLE for gastric ESD reduces overall PDB, and especially L-PDB incidence, among patients receiving antithrombotics.展开更多
<span style="font-family:;" "=""><span style="font-family:Verdana;">Endosco</span><span style="font-family:Verdana;">pic sub-mucosal dismemberment (...<span style="font-family:;" "=""><span style="font-family:Verdana;">Endosco</span><span style="font-family:Verdana;">pic sub-mucosal dismemberment (ESD) has become a settled strat</span><span style="font-family:Verdana;">egy for treatment of shallow neoplasms in the gastrointestinal tract. In three local areas, ESD was introduced to overcome traditional endoscopic mucous resecti</span><span style="font-family:Verdana;">on (EMR) and inadequate resection of the EMR, combining mout</span><span style="font-family:Verdana;">h, stomach, and the colon, for early disruptive sores. ESD was grown first in Japan since that nation has the highest predominance of gastric malignant growth on the p</span><span style="font-family:Verdana;">lanet. Endoscopic sub-mucosal analyzation causes enormous fake ulc</span><span style="font-family:Verdana;">ers with </span><span style="font-family:Verdana;">more severe dangers of intra-usable and deferred postoperative draining. However, </span><span style="font-family:Verdana;">there is no agreement in regards to the ideal peri-usable administration for the anticipation of free draining and the advancement of ulcer mending. The hugeness of this investigation is to locate a superior procedure to bring down the hazard post ESD draining and to plan to defeat the confinements of re</span><span style="font-family:Verdana;">gular EMR (endoscopic mucosal resection) and fragmented resection for</span><span style="font-family:Verdana;"> early malignant injuries in the three districts which incorporate throat, stomach, and colon. However, it has considered a standard in Eastern Asian nations and Japan because of the incredible importance of ESD. The EMR and </span><span style="font-family:Verdana;">ESD approaches are discussed in this report. Thus, the warning factors for early gastric neoplasms of PPB after ESD were established, and a superi</span><span style="font-family:Verdana;">or technique was created to mitigate the danger of ESD dying. EMR was already wide</span><span style="font-family:Verdana;">ly used for treating early neoplastic sores in the gastrointestinal tra</span><span style="font-family:Verdana;">ct;colon adenoma and colorectal tumors are widely acknowledged.</span></span>展开更多
Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Bo...Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Both patients underwent caesarean hysterectomy and experienced delayed bladder bleeding postoperatively.展开更多
BACKGROUND As a minimally invasive technique,endoscopic submucosal dissection(ESD)is widely used in treating early colorectal cancer(ECRC)and precancerous lesions(PCLs).However,a common postoperative complication-dela...BACKGROUND As a minimally invasive technique,endoscopic submucosal dissection(ESD)is widely used in treating early colorectal cancer(ECRC)and precancerous lesions(PCLs).However,a common postoperative complication-delayed postoperative bleeding(DPOB)-can significantly hinder patient recovery.AIM To build and validate a predictive model for assessing post-ESD DPOB risk in ECRC and PCL patients,utilizing logistic regression methodology.METHODS A retrospective review was conducted on ECRC/PCL 302 patients who received ESD at our hospital between July 2021 and July 2024.The cohort was stratified based on the incidence of DPOB following ESD,forming DPOB and non-DPOB groups.Through allocation,they were further allocated into model and validation cohorts.Clinical variables from both cohorts were collated and subjected to univariate analysis to determine potential factors associated with post-ESD DPOB.Subsequently,we constructed a predictive model for DPOB risk employing logistic regression analysis.Model performance assessment used receiver operating characteristic curves in both the training and validation cohorts,with internal validation accomplished via 10-fold cross-validation.RESULTS The occurrence rate of DPOB was 9.93%.Univariate analysis revealed that the number of lesions,lesion size,lesion location,degree of submucosal fibrosis,and intraoperative bleeding were significantly associated with DPOB.Binary logistic regression analysis identified the number of lesions,lesion size,lesion location,and degree of submucosal fibrosis as independent DPOB determinants.A nomogram that was developed to quantify the DPOB risk exhibited that an increment in the total score corresponded to an increased risk.The model achieved area under the curve values of 0.831 and 0.821 in the model and validation groups,respectively,with P values of 0.853 and 0.203 in the Hosmer-Lemeshow test.The model demonstrated robust discriminative performance,with an average area under the curve of 0.795(95%confidence interval:0.702-0.887)in 10-fold cross-validation.CONCLUSION Collectively,the presence of multiple lesions,lesion size of≥3 cm,lesion localization in the rectum,and severe fibrosis are significant independent predictors of DPOB in patients undergoing surgery for ECRC or PCLs.The proposed risk prediction model,which integrates these factors,demonstrates excellent predictive accuracy and clinical utility,thereby providing a valuable tool for risk stratification and postoperative management in this patient population.展开更多
BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduc...BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.展开更多
Endoscopic removal of large(≥20 mm)non-pedunculated colorectal lesions(LNPCLs)may result in major adverse events,such as delayed bleeding(DB)and delayed perforation(DP),despite closure of the mucosal defects with cli...Endoscopic removal of large(≥20 mm)non-pedunculated colorectal lesions(LNPCLs)may result in major adverse events,such as delayed bleeding(DB)and delayed perforation(DP),despite closure of the mucosal defects with clips.Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device(tissue or hydrogel)with proven bioactive properties.Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications.The aim of the present review was to systematically collect and review the currently available literature regarding the prevention of DB and DP with coverage agents after endoscopic mucosal resection or endoscopic submucosal dissection of LNPCLs.展开更多
Endoscopic ectomy of large nonpedunculated colorectal lesions(≥20 mm)might cause significant adverse incidents,such as delayed perforation and delayed bleeding,despite the closure of mucosal lesions with clips.The co...Endoscopic ectomy of large nonpedunculated colorectal lesions(≥20 mm)might cause significant adverse incidents,such as delayed perforation and delayed bleeding,despite the closure of mucosal lesions with clips.The conventional utilization of prophylactic clipping has not decreased the risk of postprocedural delayed adverse events,and additional outcomes and cost-effectiveness research is needed for patients with proximal lesions≥20 mm,in whom prophylactic clipping might be useful.Coverage of the wound after endoscopic excision offers shield protection against delayed concomitant diseases.展开更多
Welan gum is widely applied in environmental admixtures due to its good thickening and rheological properties. With its powerful charge density in the molecular structure, the competitive adsorption between welan gum ...Welan gum is widely applied in environmental admixtures due to its good thickening and rheological properties. With its powerful charge density in the molecular structure, the competitive adsorption between welan gum and other admixtures happened remarkably during the addition process. So controlling the releasing rate of welan gum will be able to improve the competitive adsorption, while having no disadvantages to its thickening and workability at the same time. The investigation of influences of the delay released welan gum（DRWG） on the fluidity and strength of cement mortar, bleeding rate and rheological properties of cement paste, adsorption amount and zeta potential of clinker single mineralogical phases, shows that there will be a better mortar workability and certain improvement in mortar strength with DRWG. For mortar with DRWG, the standing bleeding rate is 0, and there is less thixotropic, less adsorption, and a lower zeta potential value on the surface of clinker mineralogical phases.展开更多
基金Supported by the Grant-in-Aid for Scientific Research in Japan,No.21K07949.
文摘Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection(ESD)for early-stage gastrointestinal tumors.The rate of post-ESD bleeding for gastric cancer is higher(around 5%-8%)than that for esophagus,duodenum and colon cancer(around 2%-4%).Although investigations into the risk factors for post-ESD bleeding have identified several procedure-,lesion-,physician-and patient-related factors,use of antithrombotic drugs,especially anticoagulants[direct oral anticoagulants(DOACs)and warfarin],is thought to be the biggest risk factor for post-ESD bleeding.In fact,the post-ESD bleeding rate in patients receiving DOACs is 8.7%-20.8%,which is higher than that in patients not receiving anticoagulants.However,because clinical guidelines for management of ESD in patients receiving DOACs differ among countries,it is necessary for endoscopists to identify ways to prevent post-ESD delayed bleeding in clinical practice.Given that the pharmacokinetics(e.g.,plasma DOAC level at both trough and T_(max))and pharmacodynamics(e.g.,anti-factor Xa activity)of DOACs are related to risk of major bleeding,plasma DOAC level and anti-FXa activity may be useful parameters for monitoring the anti-coagulate effect and identifying DOAC patients at higher risk of post-ESD bleeding.
文摘BACKGROUND Postoperative delayed bleeding(PDB) after gastric endoscopic submucosal dissection(ESD) is the most common adverse event in patients receiving antithrombotics even with second-look endoscopy. Moreover, with the increasing prevalence of cardiovascular and cerebrovascular diseases in an aging population with associated lifestyle-related diseases, an increasing number of patients receive antithrombotics. Several attempts have been made to prevent PDB in aging population;however, a consensus has yet to be reached.AIM To examine the efficacy of third-look endoscopy(TLE) for PDB prevention.METHODS One hundred patients with early gastric neoplasms receiving antithrombotics were prospectively enrolled and subjected to ESD with TLE between February 2017 and July 2019. The primary endpoint was PDB rate, which was compared with our preset threshold. Furthermore, we divided the bleeding period into early-and late-onset PDB(E-PDB and L-PDB, respectively) and analyzed its rate. As a secondary analysis, we compared PDB rates with those of a historical control group, using propensity score matching, and calculated the PDB rates per antithrombotic agent use in each group.RESULTS In total, 96 patients and 114 specimens were finally evaluated. The overall PDB rate was 7.9%(9/114) [90%CI: 4.7-13.1, P = 0.005], while the late-and early-onset PDB rates(L-PDB and E-PDB) were 5.3% [90%CI: 2.7-9.9, P < 0.0001] and 2.6% [90%CI: 1.1-6.4, P = 0.51], respectively. Propensity score matching generated 58 matched pairs for TLE and control groups. No differences were found in overall PDB incidence(10.3% vs 20.7%, P = 0.12), whereas L-PDB occurrence significantly differed(5.2% vs 17.2%, P = 0.04) between groups. Considering antithrombotics' use, the overall PDB rate was higher for direct oral anticoagulants and multiple antithrombotics in the control group, while L-PDB incidence was lower in the TLE group for these agents(8.7% vs 23.1% and 5.0% vs 29.4%, respectively).CONCLUSION TLE for gastric ESD reduces overall PDB, and especially L-PDB incidence, among patients receiving antithrombotics.
文摘<span style="font-family:;" "=""><span style="font-family:Verdana;">Endosco</span><span style="font-family:Verdana;">pic sub-mucosal dismemberment (ESD) has become a settled strat</span><span style="font-family:Verdana;">egy for treatment of shallow neoplasms in the gastrointestinal tract. In three local areas, ESD was introduced to overcome traditional endoscopic mucous resecti</span><span style="font-family:Verdana;">on (EMR) and inadequate resection of the EMR, combining mout</span><span style="font-family:Verdana;">h, stomach, and the colon, for early disruptive sores. ESD was grown first in Japan since that nation has the highest predominance of gastric malignant growth on the p</span><span style="font-family:Verdana;">lanet. Endoscopic sub-mucosal analyzation causes enormous fake ulc</span><span style="font-family:Verdana;">ers with </span><span style="font-family:Verdana;">more severe dangers of intra-usable and deferred postoperative draining. However, </span><span style="font-family:Verdana;">there is no agreement in regards to the ideal peri-usable administration for the anticipation of free draining and the advancement of ulcer mending. The hugeness of this investigation is to locate a superior procedure to bring down the hazard post ESD draining and to plan to defeat the confinements of re</span><span style="font-family:Verdana;">gular EMR (endoscopic mucosal resection) and fragmented resection for</span><span style="font-family:Verdana;"> early malignant injuries in the three districts which incorporate throat, stomach, and colon. However, it has considered a standard in Eastern Asian nations and Japan because of the incredible importance of ESD. The EMR and </span><span style="font-family:Verdana;">ESD approaches are discussed in this report. Thus, the warning factors for early gastric neoplasms of PPB after ESD were established, and a superi</span><span style="font-family:Verdana;">or technique was created to mitigate the danger of ESD dying. EMR was already wide</span><span style="font-family:Verdana;">ly used for treating early neoplastic sores in the gastrointestinal tra</span><span style="font-family:Verdana;">ct;colon adenoma and colorectal tumors are widely acknowledged.</span></span>
文摘Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Both patients underwent caesarean hysterectomy and experienced delayed bladder bleeding postoperatively.
文摘BACKGROUND As a minimally invasive technique,endoscopic submucosal dissection(ESD)is widely used in treating early colorectal cancer(ECRC)and precancerous lesions(PCLs).However,a common postoperative complication-delayed postoperative bleeding(DPOB)-can significantly hinder patient recovery.AIM To build and validate a predictive model for assessing post-ESD DPOB risk in ECRC and PCL patients,utilizing logistic regression methodology.METHODS A retrospective review was conducted on ECRC/PCL 302 patients who received ESD at our hospital between July 2021 and July 2024.The cohort was stratified based on the incidence of DPOB following ESD,forming DPOB and non-DPOB groups.Through allocation,they were further allocated into model and validation cohorts.Clinical variables from both cohorts were collated and subjected to univariate analysis to determine potential factors associated with post-ESD DPOB.Subsequently,we constructed a predictive model for DPOB risk employing logistic regression analysis.Model performance assessment used receiver operating characteristic curves in both the training and validation cohorts,with internal validation accomplished via 10-fold cross-validation.RESULTS The occurrence rate of DPOB was 9.93%.Univariate analysis revealed that the number of lesions,lesion size,lesion location,degree of submucosal fibrosis,and intraoperative bleeding were significantly associated with DPOB.Binary logistic regression analysis identified the number of lesions,lesion size,lesion location,and degree of submucosal fibrosis as independent DPOB determinants.A nomogram that was developed to quantify the DPOB risk exhibited that an increment in the total score corresponded to an increased risk.The model achieved area under the curve values of 0.831 and 0.821 in the model and validation groups,respectively,with P values of 0.853 and 0.203 in the Hosmer-Lemeshow test.The model demonstrated robust discriminative performance,with an average area under the curve of 0.795(95%confidence interval:0.702-0.887)in 10-fold cross-validation.CONCLUSION Collectively,the presence of multiple lesions,lesion size of≥3 cm,lesion localization in the rectum,and severe fibrosis are significant independent predictors of DPOB in patients undergoing surgery for ECRC or PCLs.The proposed risk prediction model,which integrates these factors,demonstrates excellent predictive accuracy and clinical utility,thereby providing a valuable tool for risk stratification and postoperative management in this patient population.
文摘BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.
文摘Endoscopic removal of large(≥20 mm)non-pedunculated colorectal lesions(LNPCLs)may result in major adverse events,such as delayed bleeding(DB)and delayed perforation(DP),despite closure of the mucosal defects with clips.Topical application of a coverage agent refers to the creation of a shield with a biocompatible medical device(tissue or hydrogel)with proven bioactive properties.Coverage of the eschar after endoscopic resection provides shielding protection to prevent delayed complications.The aim of the present review was to systematically collect and review the currently available literature regarding the prevention of DB and DP with coverage agents after endoscopic mucosal resection or endoscopic submucosal dissection of LNPCLs.
文摘Endoscopic ectomy of large nonpedunculated colorectal lesions(≥20 mm)might cause significant adverse incidents,such as delayed perforation and delayed bleeding,despite the closure of mucosal lesions with clips.The conventional utilization of prophylactic clipping has not decreased the risk of postprocedural delayed adverse events,and additional outcomes and cost-effectiveness research is needed for patients with proximal lesions≥20 mm,in whom prophylactic clipping might be useful.Coverage of the wound after endoscopic excision offers shield protection against delayed concomitant diseases.
基金Funded by the National Natural Science Foundation of China(No.51202173)
文摘Welan gum is widely applied in environmental admixtures due to its good thickening and rheological properties. With its powerful charge density in the molecular structure, the competitive adsorption between welan gum and other admixtures happened remarkably during the addition process. So controlling the releasing rate of welan gum will be able to improve the competitive adsorption, while having no disadvantages to its thickening and workability at the same time. The investigation of influences of the delay released welan gum（DRWG） on the fluidity and strength of cement mortar, bleeding rate and rheological properties of cement paste, adsorption amount and zeta potential of clinker single mineralogical phases, shows that there will be a better mortar workability and certain improvement in mortar strength with DRWG. For mortar with DRWG, the standing bleeding rate is 0, and there is less thixotropic, less adsorption, and a lower zeta potential value on the surface of clinker mineralogical phases.
