Annals of medicine · 2025
Stratified and propensity score matching analysis of the effectiveness of fibrin glue in preventing postoperative bleeding after endoscopic submucosal dissection.
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Zhang Die, Han Lu, Jin Ruiri, Liu Zide, Zeng Shuyan, Zeng Chunyan, Chen Youxiang
Аннотация
BACKGROUND: Endoscopic submucosal dissection (ESD) is a commonly used treatment for superficial lesions of the upper gastrointestinal tract, of which the most common complication is postoperative bleeding. This retrospective study mainly aimed at assessing the effect of intraoperative fibrin glue (FG) spraying on postoperative bleeding in patients with early esthe ophageal cancer (EEC) and early gastric cancer (EGC).
METHODS: A retrospective analysis of FG uses during ESD was conducted in 362 patients with early upper gastrointestinal malignancy. 362 patients who received ESD were divided into the FG group and the conventional group, comparing their postoperative bleeding rate, acute postoperative bleeding rate, and delayed postoperative bleeding rate using stratified analysis and propensity score matching (PSM) to eliminate potential confounding factors. Univariate and multivariate logistic regression were implemented to investigate the risk variables for surgical hemorrhage following early upper gastrointestinal malignancy.
RESULTS: The results of stratification based on intraoperative bleeding showed that the use of FG in the intraoperative bleeding group of EGC patients undergoing ESD could effectively reduce bleeding within 48 h after surgery (p = 0.039), whereas the application of FG did not affect postoperative bleeding in patients with early esophageal cancer after ESD. After utilizing PSM, 102 pairs of matched subjects were obtained, eliminating differences in age, lesion size and depth, and intraoperative bleeding between the two groups. The postoperative bleeding rate in the FG group was 2.9%, while in the conventional group, it was 12.7% (p = 0.009); the bleeding rates within 48 h after ESD were 1.0% and 7.8%, respectively (p = 0.035), which were statistically significant. A logistic regression analysis revealed that intraoperative bleeding was a risk factor for postoperative bleeding (OR, 4.00; 95% CI, 1.47-10.84; p = 0.006).
CONCLUSIONS: Intraoperative spraying of FG may help to reduce the incidence of postoperative bleeding after ESD, especially acute postoperative bleeding in patients with EGC.
METHODS: A retrospective analysis of FG uses during ESD was conducted in 362 patients with early upper gastrointestinal malignancy. 362 patients who received ESD were divided into the FG group and the conventional group, comparing their postoperative bleeding rate, acute postoperative bleeding rate, and delayed postoperative bleeding rate using stratified analysis and propensity score matching (PSM) to eliminate potential confounding factors. Univariate and multivariate logistic regression were implemented to investigate the risk variables for surgical hemorrhage following early upper gastrointestinal malignancy.
RESULTS: The results of stratification based on intraoperative bleeding showed that the use of FG in the intraoperative bleeding group of EGC patients undergoing ESD could effectively reduce bleeding within 48 h after surgery (p = 0.039), whereas the application of FG did not affect postoperative bleeding in patients with early esophageal cancer after ESD. After utilizing PSM, 102 pairs of matched subjects were obtained, eliminating differences in age, lesion size and depth, and intraoperative bleeding between the two groups. The postoperative bleeding rate in the FG group was 2.9%, while in the conventional group, it was 12.7% (p = 0.009); the bleeding rates within 48 h after ESD were 1.0% and 7.8%, respectively (p = 0.035), which were statistically significant. A logistic regression analysis revealed that intraoperative bleeding was a risk factor for postoperative bleeding (OR, 4.00; 95% CI, 1.47-10.84; p = 0.006).
CONCLUSIONS: Intraoperative spraying of FG may help to reduce the incidence of postoperative bleeding after ESD, especially acute postoperative bleeding in patients with EGC.