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. 2019 May;22(3):567-575.
doi: 10.1007/s10120-018-0878-y. Epub 2018 Sep 28.

The search, coagulation, and clipping (SCC) method prevents delayed bleeding after gastric endoscopic submucosal dissection

Motoi Azumi  1 , Manabu Takeuchi  2 , Youhei Koseki  1 , Masaru Kumagai  1 , Yoko Kobayashi  1 , Masafumi Takatsuna  1 , Aiko Yoshioka  1 , Seiichi Yoshikawa  1 , Tsutomu Miura  1 , Shuji Terai  3
Affiliations

The search, coagulation, and clipping (SCC) method prevents delayed bleeding after gastric endoscopic submucosal dissection

Motoi Azumi et al. Gastric Cancer. 2019 May.

Erratum in

Abstract

Background: Delayed bleeding is an important complication after gastric endoscopic submucosal dissection (ESD). The search, coagulation, and clipping (SCC) method can be used to prevent delayed bleeding after ESD. However, its safety and efficacy are unclear. We compared the SCC method with post-ESD coagulation (PEC) to clarify the safety and efficacy of the SCC method for preventing delayed bleeding after gastric ESD.

Methods: This retrospective study included 438 patients (478 lesions) who underwent gastric ESD. Multivariate logistic regression analysis was performed to identify the significant independent factors associated with delayed bleeding and we performed propensity-score matching (PSM) to reduce the effect of procedure-selection bias of SCC method.

Results: Of the 438 patients, 216 underwent PEC and 222 underwent SCC. Delayed bleeding was significantly less common in the SCC than in the PEC (2.6% vs. 7.2%; P = 0.013). Among patients treated with antithrombotic therapy, the delayed bleeding rate was lower in the SCC group than in the PEC group; however, the difference was not significant (P = 0.15). The SCC method was found to be a significant independent factor for the prevention of delayed bleeding. PSM was performed in 156 patients in the PEC group and SCC group. There was a significant difference in the incidence of bleeding in the PEC and SCC groups (P = 0.013). No patient had perforation/bleeding associated with the SCC method.

Conclusions: Our findings suggest that the SCC method is a simple, safe, and effective approach for preventing delayed bleeding after gastric ESD.

Keywords: Clip; Delayed bleeding; Gastric endoscopic submucosal dissection.

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Conflict of interest statement

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study, or the equivalent, was obtained from all patients.

Conflict of interest

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
a Blood vessel pre-coagulated during ESD is observed. It was thought to be a penetrating branch passing through the muscle layer. Thus, a clip was placed. b Blood vessel could not be identified during ESD but could be identified on observation using GIF-H260Z (Olympus, Tokyo, Japan). The blood vessel is small, but a pulse was detected. Thus, it was diagnosed as an artery, and a clip was placed. ESD endoscopic submucosal dissection
Fig. 2
Fig. 2
a Post-ESD ulcer after completion of the PEC method. PEC post-endoscopic submucosal dissection coagulation. b Post-ESD ulcer after completion of the SCC method. SCC search, coagulation, and clipping, ESD endoscopic submucosal dissection
See this image and copyright information in PMC

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