Endoscopic Doppler US for the prevention of ulcer bleeding after endoscopic submucosal dissection for early gastric cancer: a preliminary study (with video).
BACKGROUND
After endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), delayed bleeding occurs in 1.7% to 38% of cases. Routine coagulation of all nonbleeding visible vessels (NBVVs) in post-ESD ulcers is currently performed as standard practice, but it cannot eliminate bleeding. An endoscopic Doppler US (DOP-US) probe system has possible benefits for the prediction of recurrent bleeding in peptic ulcer hemorrhage.


OBJECTIVE
To establish optimum use and evaluate feasibility of DOP-US for post-ESD ulcers.


METHODS
Case series study.


METHODS
Cancer referral center.


METHODS
Eight patients with mucosal EGC larger than 2 cm without ulceration or scarring and 2 patients with EGC less than 3 cm with scarring.


METHODS
We searched for a positive DOP-US signal (DOP-US+), which was defined as pulsatile sound at a depth of 1.5 mm, and NBVVs or areas with DOP-US+ were coagulated with hemostatic forceps. A multibending, double-channel videoendoscope that was fitted with a transparent hood was used.


METHODS
Detectability of DOP-US signals in post-ESD ulcers.


RESULTS
One of 13 oozing bleeding sites, 24 (18%) of 136 NBVVs, and 7 areas without any bleeding stigmata had DOP-US+ and were coagulated until the signal became silent. One hundred twelve NBVVs (82%) and 8 adherent clots without DOP-US signals were left untreated. No delayed bleeding was experienced at 30 days. Median time required for Doppler examination was 34 minutes, but it improved to 18 and 19 minutes in patients 9 and 10, respectively.


CONCLUSIONS
DOP-US might be helpful in the endoscopic management of post-ESD ulcers in EGC. Our setting and maneuver warrant further investigation to clarify whether DOP-US can reduce delayed bleeding and avoid unnecessary coagulation for NBVVs in post-ESD ulcers.
Uedo
Noriya
N
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Takeuchi
Yoji
Y
Ishihara
Ryu
R
Hanaoka
Noboru
N
Inoue
Takuya
T
Kizu
Takashi
T
Higashino
Koji
K
Iishi
Hiroyasu
H
Tatsuta
Masaharu
M
Chak
Amitabh
A
Wong
Richard C K
RC
D017115:Catheter Ablation / Q000379:methods; D004210:Dissection / Q000009:adverse effects*; D042241:Early Diagnosis; D019160:Endosonography / Q000295:instrumentation*; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013276:Stomach Ulcer / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000295:instrumentation*; D014741:Video Recording