Endoscopy international open · 2025
Clinical feasibility of gastric endoscopic submucosal dissection in patients on glucocorticoids or immunomodulators: Propensity-score-matched study.
СтатьяНазвание и аннотация: Перевод в очереди
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Fukuya Hiroki, Ihara Eikichi, Iboshi Yoichiro, Sumida Yorinobu, Yoshimura Daisuke, Hamada Shohei, Sasaki Taisuke, Ohkubo Akito, Itonaga Shuichi, Homma Hitoshi, Okitsu Ryota, Ohno Akihisa, Esaki Mitsuru, Harada Naohiko
Аннотация
BACKGROUND AND STUDY AIMS: Evidence on gastric endoscopic submucosal dissection (ESD) under glucocorticoids or immunomodulators (GC/IM) is limited. We evaluated whether GC/IM use affects gastric ESD outcomes.
PATIENTS AND METHODS: We retrospectively analyzed 411 consecutive ESDs (April 2017-April 2022). GC/IM users (n = 32) were compared with controls (n = 379); 1:3 propensity-score matching yielded 27 vs 81 patients. The primary outcome was overall complications, defined as a composite of pain, fever, delayed bleeding, and delayed perforation. Secondary outcomes were each component, intra-procedure perforation, hospital stay, and use of symptom-directed treatments (analgesics, antipyretics, antibiotics).
RESULTS: Overall complications were more frequent with GC/IM than controls (44.4% vs 21.0%; P = 0.024; relative risk [RR] 2.11, 95% confidence interval 1.16-3.84), driven by pain (40.7% vs 18.5%; P = 0.035) and fever (11.1% vs 1.2%; P = 0.047). Rates of major complications did not differ (delayed bleeding 3.7% vs 2.5%; delayed perforation 0% vs 0%). Intra-procedure perforation was numerically higher (7.4% vs 3.7%) without significance. Median (interquartile range) hospital stay showed a small, non-significant difference (9 [7-12] vs 8 [7-9] days; P = 0.064). Symptom management was used more often with GC/IM (analgesics 25.9% vs 3.7%, P = 0.002; antipyretics 7.4% vs 2.5%, P = 0.270; antibiotics 7.4% vs 3.7%, P = 0.597).
CONCLUSIONS: In patients receiving GC/IM, gastric ESD was associated with a higher incidence of minor, clinically managed events-chiefly pain and transient fever-whereas major complications remained uncommon. With close monitoring and prompt symptom-directed care, gastric ESD appeared clinically feasible, albeit with slightly greater resource use and observation time.
PATIENTS AND METHODS: We retrospectively analyzed 411 consecutive ESDs (April 2017-April 2022). GC/IM users (n = 32) were compared with controls (n = 379); 1:3 propensity-score matching yielded 27 vs 81 patients. The primary outcome was overall complications, defined as a composite of pain, fever, delayed bleeding, and delayed perforation. Secondary outcomes were each component, intra-procedure perforation, hospital stay, and use of symptom-directed treatments (analgesics, antipyretics, antibiotics).
RESULTS: Overall complications were more frequent with GC/IM than controls (44.4% vs 21.0%; P = 0.024; relative risk [RR] 2.11, 95% confidence interval 1.16-3.84), driven by pain (40.7% vs 18.5%; P = 0.035) and fever (11.1% vs 1.2%; P = 0.047). Rates of major complications did not differ (delayed bleeding 3.7% vs 2.5%; delayed perforation 0% vs 0%). Intra-procedure perforation was numerically higher (7.4% vs 3.7%) without significance. Median (interquartile range) hospital stay showed a small, non-significant difference (9 [7-12] vs 8 [7-9] days; P = 0.064). Symptom management was used more often with GC/IM (analgesics 25.9% vs 3.7%, P = 0.002; antipyretics 7.4% vs 2.5%, P = 0.270; antibiotics 7.4% vs 3.7%, P = 0.597).
CONCLUSIONS: In patients receiving GC/IM, gastric ESD was associated with a higher incidence of minor, clinically managed events-chiefly pain and transient fever-whereas major complications remained uncommon. With close monitoring and prompt symptom-directed care, gastric ESD appeared clinically feasible, albeit with slightly greater resource use and observation time.