The Effect Of Titanium Clip Closure On The Healing Of Iatrogenic Ulcer After ESD Of Stomach

Objective: To study the effect of titanium clip closure on the healing time and quality of iatrogenic ulcer after endoscopic submucosal dissection(ESD)and the complications after ESD.Methods:From January 2016 to December 2018,106 patients with precancerous lesions of gastric cancer and early gastric cancer who underwent ESD in our hospital were enrolled.According to using titanium clips or not to close the iatrogenic ulcer after ESD,the patients were divided into two groups: the closure group and the non-closure group.Gender,age,length of hospital stay,bleeding,perforation,fever and iatrogenic ulcer after ESD were recorded.Gastroscopy was reexamined 6 weeks later.The ulcer size and ulcer healing quality were recorded again.The healing speed and quality of iatrogenic ulcer were compared between the two groups 6 weeks later.The bleeding,perforation and infection after ESD were compared between the two groups.SPSS24 statistical software was used for data analysis.Results:1)In this study,106 patients were included,63 in the closed group,including 30 males and 33 females;43 in the open group,including 24 males and 19 females.There was no significant difference in gender ratio between the two groups(P > 0.05).There was no significant difference in the mean age between the closure group and the non-closure group(53.16 + 10.03 vs 54.62 + 7.89,P > 0.05).There was no significant difference in the average hospitalization days between the closed group and the open group(8.10 + 2.58 vs 7.88 + 2.62,P > 0.05).2)There was no significant difference in ulcer area between closed group and open group(405.19(+393.93)vs 457.47(+449.71),P=0.659).The area of ulcer in closed group was significantly smaller than that in open group at 6 weeks after operation(3.05(+4.45 vs 17.84(+24.59),P=0.000).The reduction rate of ulcer area in closure group was significantly higher than that in exclusion group at 6 weeks after operation(99.2% vs 93.1%,P = 0.003).3)The healing quality of closure group was better than that of non-closure group(P=0.000).The healing rate of the closure group(82.5%)was higher than that of the non-closure group(48.8%)with statistical difference(P=0.000).4)Postoperative hemorrhage occurred in 1 case(1.6%)in the closure group,which was much less than that in 5 cases(11.6%)in the non-closure group(P=0.039).Two patients had perforation after operation and closed with titanium clip under endoscopy,which healed well.One patient in the non-closure group had perforation after operation and improved after conservative treatment,which has no statistical difference between the two groups(P>0.05).5)Logistic regression analysis showed that the healing of iatrogenic ulcer after ESD closure with titanium clip was closely related to the healing of ulcer after ESD closure with titanium clip(odds ratio,4.461 [95% CI(1.793-11.100),P = 0.001).The area under the curve(AUC)was 0.689(P = 0.002),which has statistical significance.Conclusion: Titanium clip closure can promote the healing of iatrogenic ulcer after ESD and reduce the occurrence of bleeding after ESD.