Jilin Province Great Great Pharmaceutical Co. LTD

Jilin Province Broadwell Pharmaceutical Co., LTD. Welcome you!

Service hotline:+86-431-85639055

博大伟业
imgboxbg

HEALTH SCIENCE

Your current location:
Homepage
/
/
/
Experience in management of complications after endoscopic submucosal dissection

Experience in management of complications after endoscopic submucosal dissection

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-11-18
  • Views:0

(Summary description)

Experience in management of complications after endoscopic submucosal dissection

(Summary description)

  • Categories:Stomach healthy
  • Author:
  • Origin:
  • Time of issue:2020-11-18
  • Views:0
Information

  With the development and wide application of endoscopic technology, the detection rate of early tumors in the digestive tract has been greatly improved. A large number of studies have shown that endoscopic treatment of patients with early gastrointestinal tumors can achieve the same effect as surgical treatment. At present, Endoscopic submucosal dissection (ESD) has been recognized as a standard method for early gastric cancer and precancerous lesions. It has the advantages of less trauma and quick recovery after surgery. However, there is a large range of artificial ulcers after the lesion is peeled off, so the management of postoperative complications cannot be ignored.

  Today we are honored to invite Professor Jiang Bo, Director of the Department of Internal Medicine and Director of the Digestive Center, Tsinghua University Beijing Tsinghua Chang Gung Memorial Hospital, to share his clinical experience with us.

  With the widespread application of ESD in clinical practice, how is the current clinical application of this treatment method?

  What are the issues that need our further attention?

  Professor Jiang Bo: ESD can effectively remove precancerous lesions or early cancer of the gastric mucosa in a large mass, and residual lesions and recurrence are rare, and the 5-year survival rate is high. At present, ESD is a relatively mature technology.

  ESD artificial ulcers are similar to peptic ulcers, but there are many differences. First, the wound surface after ESD peeling off the lesion reaches the submucosa. Unlike endoscopic mucosal resection (EMR), which causes vertical wounds that are easy to close, ESD can artificially cause ulcers. Larger lesions (more than 2cm) plus the edges of the resection can reach a diameter of more than 3cm. So wound closure is more difficult.

  Most peptic ulcers are related to high acid state, and the patients are mostly young and middle-aged; while artificial ulcers are the product of endoscopic surgery to remove early gastric cancer or precancerous lesions, often accompanied by a background of severe atrophic gastritis with low acid. This involves some of our subsequent postoperative management issues, such as bleeding, ulcer healing and so on. So what should we do in these situations?

  The earlier the ulcer heals after ESD, the higher the healing quality, the smaller the clinical symptoms caused by the ulcer, and the lower the risk of complications such as bleeding. If the patient has acute bleeding during the operation, it can be dealt with during the operation. However, delayed bleeding after surgery requires the use of proton pump inhibitors (PPI) according to international and domestic consensus. Continuous use of PPI in the clinic can control the pH of the stomach environment at around 6-7. In this case, the bleeding of the patient will be significantly reduced, which is also conducive to the healing of artificial ulcers.

  At the same time, for ulcers that are difficult to heal, a combination of drugs should be used as much as possible, that is, a mucosal protective agent is added to suppress the secretion of gastric acid. Mucosal protective agents such as polyprezinc are widely used in Japan, and their usage includes spraying on the ulcer surface during surgery and oral administration after surgery. On the one hand, it promotes ulcer healing through the mucosal protection, antioxidant function and membrane stabilization of independent prostaglandins. On the other hand, it stimulates the synthesis of insulin growth factor I, promotes mucosal repair through endothelial cells, and increases the quality of ulcer healing.    How to routinely reduce the occurrence of postoperative complications in the subsequent clinical practice is a direction of our efforts. In terms of specific operation, the wound surface is closed with a titanium clip first, followed by the use of acid inhibitory drugs (PPI), and the use of ulcer surface protection such as mucosal protective agents. These three points are indispensable.

  What are the important factors for ulcer healing after ESD? How to pay attention and improve?

  Professor Jiang Bo: Delayed healing of ulcers caused by ESD is mostly related to delayed mucosal formation at the edges of the ulcer and immature granulation tissue at the bottom of the ulcer. The maturation of granulation tissue requires the regeneration of blood vessels in the granulation tissue at the bottom of the ulcer, the migration of epithelial cells at the edge of the ulcer and the reconstruction of the granulation structure.

  Stomach ESD surgery, the pH value of the stomach environment is an important factor affecting ulcer healing and bleeding risk, so PPI drugs need to be used continuously during and after surgery. In ESD surgery, the wound should be closed as much as possible, and the wound that cannot be closed must be protected with drugs, such as mucosal protectants. At present, our country has not produced a dosage form that is more suitable for direct spray under the endoscope, but the granular polyprezinc is sprayed locally under the endoscope, and the effect is still relatively good. PPI combined with mucosal protective agent can better control delayed bleeding and promote the healing of ulcers.

  What aspects should be paid attention to in the medication experience and treatment course selection of artificial ulcers after ESD?

  Professor Jiang Bo: The consensus guidelines generally recommend the use of adequate and continuous proton pump inhibitors (PPI) for 4-8 weeks, with additional mucosal protective agents when necessary. The use of PPI drugs is divided into two aspects: intravenous PPI generally takes 5-7 days after ESD (the high-incidence period of late bleeding), and oral PPI generally lasts 3-4 weeks after ESD. Studies have shown that PPI combined with mucosal protective agents can achieve significant synergistic effects. The healing rate of artificial ulcers is significantly higher than that of the PPI group alone, and the combined drugs can significantly improve the quality of healing. The role of mucosal protective agents is not only to promote the healing of ulcers, It also has a certain protective effect on the stress response of the entire stomach mucosa. From a clinical point of view, the routine application of mucosal protective agents is generally about 2-3 weeks after ESD. A Meta analysis published in the International Journal of Clinical Biochemistry and Nutrition in 2015 showed that PPI combined with mucosal protective agent has a higher ulcer healing rate than PPI alone (45.8% vs 34.4%), and the combination of PPI and mucosal protective agent is still Can shorten the ulcer healing time. Therefore, the clinical significance of adding mucosal protective agents is mainly to improve the ulcer healing rate; at the same time, in the Japanese Hepato-gastroenterology magazine in 2010, it was reported that lansoprazole combined with polyprezinc was used to treat ulcers after ESD, and the combined application of patients’ ulcer healing scores It is significantly better than the patients in the PPI group alone, and the incidence of ulcer base protrusion is lower by 1.3% vs 20.7%.   Combined with the development process and experience of Japan's ESD, how will my country's ESD develop in the future?   Professor Jiang Bo: Japan is the origin of ESD. At that time, there was no titanium clip closure technology. The ulcer surface of each patient was exposed and open. There was only one intervention-mucosal protective agent. In my country, ESD was not fully implemented until 2005. Therefore, the situation in China is not the same as in Japan.

  First of all, the mucosal protective agent in our country currently has no dosage form that is relatively suitable for direct application under endoscopy. Generally, after ESD, the patient takes the drug by himself to form a protective film. With the development, many Japanese mucosal protective agents have also entered the country, so that the development of ESD in my country can "two ways in parallel". In order to promote the healing of ulcers, the use of PPI combined with mucosal protective agents still needs to be promoted.

  The development of things is an ongoing process. Under the current circumstances, the management of complications after ESD in our country still requires effective treatment with drugs, that is, PPI combined with mucosal protective agents for double protection.

Scan the QR code to read on your phone

Jilin Province Great Great Pharmaceutical Co. LTD

Service hotline

+86-431-81158731

CONTACT US

Jilin Province Great Great Pharmaceutical Co. LTD

Jilin Province Great Great Pharmaceutical Co. LTD
Jilin Province Great Great Pharmaceutical Co. LTD
Jilin Province Great Great Pharmaceutical Co. LTD
Jilin Province Great Great Pharmaceutical Co. LTD
Jilin Province Great Great Pharmaceutical Co. LTD
Jilin Province Great Great Pharmaceutical Co. LTD

Liaoyuan Production Base: No. 158 Fortune Road, Liaoyuan Economic Development Zone, Jilin Province

Tel:+86-437-6998023

Changchun R&D Center: No. 3786 Juye Street, Jingyue Development Zone, Changchun City, Jilin Province
Tel:+86-431-81158731(Marketing center)

Tel:+86-431-81158756(Research and development center)

Beijing Office: Room 901, Building F, Kaixuan City, 170 Beiyuan Road, Chaoyang District, Beijing
Tel:+86-10-58236233

Medication consultation, feedback on medication adverse reaction, and user complaint telephone:0437-5029815 

NO PUBLIC

Jilin Province Great Great Pharmaceutical Co. LTD

Scan and follow the official official account

Copyright © Jilin Province Great Great Pharmaceutical Co. LTD        吉ICP备20002630号

Website construction:300.cn Changchun   management     

Jilin Province Great Great Pharmaceutical Co. LTD