Assessment of intraoperative bleeding during endoscopic submucosal dissection and endoscopic hemostasis using high-frequency hemostatic forceps

Shotaro Enomoto, Naohisa Yahagi, Mitsuhiro Fujishiro, Masashi Oka, Yosuke Muraki, Hisanobu Deguchi, Kazuki Ueda, Izumi Inoue, Takao Maekita, Hirohito Magari, Chizu Mukoubayashi, Kazuyuki Nakazawa, Mikitaka Iguchi, Kimihiko Yanaoka, Kenji Arii, Hideyuki Tamai, Masao Omata, Masao Ichinose

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Abstract

Objective: Endoscopic submucosal dissection (ESD) is a novel endoluminal endoscopic surgical technique that enables en bloc resection of early-stage malignant gastric tumors. However, intraoperative bleeding is a problem with this technique. The aim of this study is to assess the severity and source of bleeding during ESD of gastric tumors. Patients and Methods: Sixteen gastric tumors were treated with ESD, and bleeding during ESD was controlled with high-frequency electro-coagulation hemostatic forceps and an endoscope equipped with a water-jet system. The frequency of bleeding, the number of occurrences of spurting- and oozing-type bleeding, and the frequency of electrocoagulation were assessed. Results: Bleeding occurred an average of 10.8 times per patient (spurting-type bleeding, including projectile bleeding, 67.6%; oozing-type bleeding, 32.4%). Except for one patient, spurting-type bleeding occurred more frequently than oozing-type bleeding in all cases, and it occurred significantly more often in the middle third of the stomach in male patients under 60 years of age. The hemostatic forceps effectively and reliably controlled spurting type bleeding without adverse effects. Conclusions: Spurting-type bleeding occurred more frequently than oozing-type bleeding during ESD. For the purpose of controlling intraoperative bleeding, especially spurting-type bleeding, a method of endoscopic hemostasis using high-frequency hemostatic forceps in combination with an endoscope equipped with a water-jet system proved to be useful.

Original languageEnglish
Pages (from-to)124-129
Number of pages6
JournalJournal of the Wakayama Medical Society
Volume60
Issue number4
Publication statusPublished - 2009 Dec

Keywords

  • Bleeding
  • Endoscopic submucosal dissection
  • Gastric cancer
  • Hemostatic forceps

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Enomoto, S., Yahagi, N., Fujishiro, M., Oka, M., Muraki, Y., Deguchi, H., Ueda, K., Inoue, I., Maekita, T., Magari, H., Mukoubayashi, C., Nakazawa, K., Iguchi, M., Yanaoka, K., Arii, K., Tamai, H., Omata, M., & Ichinose, M. (2009). Assessment of intraoperative bleeding during endoscopic submucosal dissection and endoscopic hemostasis using high-frequency hemostatic forceps. Journal of the Wakayama Medical Society, 60(4), 124-129.