Development of postoperative bleeding management in gastric endoscopic submucosal dissection Article Swipe
Yusuke Suzuki
,
Mitsuru Esaki
,
Eikichi Ihara
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1111/den.14744
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1111/den.14744
In this issue of Digestive Endoscopy, Tang et al. (2023)1 reported that an aspiration and coagulation (AC) technique to visualize residual vessels on postgastric endoscopic submucosal dissection (ESD) ulcers reduced postoperative bleeding in a single-center retrospective study. In the study, 280 patients with 280 lesions in the AC group and 516 patients with 516 lesions in the control group were enrolled. After ESD, the visible vessels in the ulcer were routinely coagulated using hemostatic forceps (Coagrasper; FD-410LR, Olympus, Tokyo, Japan). Additional aspiration and coagulation techniques were performed in the AC group. After aspirating the target tissue for 1–2 s, coagulation was performed using forceps if there was active bleeding or exposed vessels from the suction area. These techniques were adapted for the whole ulcers. Postoperative bleeding was defined as hematemesis, hematochezia, or melena after ESD, active bleeding, or thrombus attached to the artificial ulcer during emergency endoscopy after ESD, a hemoglobin drop ≥2 g/dL or positive fecal occult blood 48 h after ESD. Massive hemorrhage after ESD was characterized by bleeding that caused changes in the vital signs and necessitated emergency endoscopic intervention to stop the bleeding. Propensity score matching (1:1) was used to compensate for potential bias due to the retrospective nature of the study. The study found that the time required for the AC procedure was 4.0 ± 1.3 min, with no significant difference between the total procedure time of the AC and the control groups (54.6 ± 39.5 vs. 52.3 ± 39.0 min, P = 0.435). After matching with 242 pairs, the AC group showed significantly lower rates of massive hemorrhage (0.4% vs. 3.3%, P = 0.037) and overall postoperative bleeding (1.2% vs. 5.0%, P = 0.032) than the control group. Postoperative bleeding is a critical complication that can lead to hemorrhagic shock, the need for blood transfusions, and emergency hemostatic interventions, significantly affecting patient outcomes.2 Risk factors for postoperative bleeding include chronic kidney disease with hemodialysis and anticoagulant therapy, large tumor size, and a tumor location in the lower-third. In addition, risk increases when multiple factors coincide. The Bleeding after ESD Trend from Japan (BSET-J) score has been proposed as a predictive model of postoperative bleeding.3 The BSET-J score classifies bleeding risk into four categories: low-risk, intermediate-risk, high-risk, and very high-risk by summing the points of each postoperative bleeding risk. The postoperative bleeding rates were 11.4% and 29.7% in the high-risk and very high-risk groups, respectively. ESD for patients at risk of postoperative bleeding has been increasing, owing to the aging patient population; therefore, efforts to manage ESD-associated complications, focusing on delayed bleeding, are actively being researched. Prophylactic approaches for postoperative bleeding can be classified into two categories: targeting medications and targeting post-ESD ulcers. In a prospective randomized controlled trial, Uedo et al.4 reported that proton pump inhibitors (PPI) were more effective than H2-receptor antagonists (H2RAs) in preventing postoperative bleeding. Several studies, including meta-analyses, have reported similar results, suggesting that strong inhibition of gastric acid secretion after ESD may prevent postoperative bleeding. In recent years, potassium-competitive acid blockers (P-cabs) have attracted considerable attention as potential inhibitors of gastric acid secretion. Therefore, it is expected to be even more effective in preventing postoperative bleeding. As an approach to targeting post-ESD ulcers, Tsuji et al.5 reported an endoscopic tissue shielding method using polyglycolic acid (PGA) sheets and fibrin glue to cover post-ESD ulcers. PGA sheets are used not only in the field of surgery, but also in endoscopy because of their role in assisting tissue repair. Using PGA sheets and adhering them to post-ESD ulcers with fibrin glue is expected to help repair post-ESD ulcers and reduce postoperative bleeding. Although several meta-analyses and retrospective studies have suggested the efficacy of PGA in preventing postoperative bleeding, no significant preventive effects were found in a prospective study.6 One reason for this may be the challenge in effectively positioning the PGA sheet over the ulcer, as the sheet tends to crumple and detach easily. Several techniques for supporting PGA sheet placement have been reported.7 Another approach for treating post-ESD ulcers is closure. Lee et al.8 conducted a prospective study on post-ESD ulcer closure using a detachable snare. However, they found no significant difference in the postoperative bleeding rates between the closure and nonsutured groups. The problem with the closure technique is that achieving complete closure is challenging. In the study by Lee et al., only 60% of the cases were completely closed, and 40% of the cases were classified as incomplete or failed. In recent years, significant advancements have been made in the development of endoscopic suture devices and needle forceps. Consequently, techniques yielding high rates of complete sutures have emerged, including the reopenable clip-over-the-line method (ROLM). Further investigating the efficacy of these devices and techniques in preventing postoperative bleeding is desirable. Takizawa et al.9 reported that post-ESD coagulation (PEC) of visible residual vessels on the ulcer surface reduced the postoperative bleeding rate in a retrospective study. Based on these results, the coagulation of visible residual vessels in post-ESD ulcer is routinely performed using hemostatic forceps or ESD devices. The AC technique has been developed as a more advanced method of PEC. The authors proposed that the AC technique enables the identification of fragile or damaged blood vessels at high risk of delayed bleeding during the ESD procedure by intentionally inducing bleeding through physical stimulation via suction. Potential points of delayed bleeding can be coagulated prophylactically. This method is expected to significantly improve conventional coagulation methods by providing a more efficient approach that does not require the use of additional devices. The limitation of this method is the potential risk of perforation because excessive suction and coagulation may damage the muscle layer, especially when damage to the muscle layer occurs during ESD. Additionally, the limitation of this study is a retrospective analysis conducted at a single center. Although numerous studies have been conducted to prevent delayed bleeding, no method except for PPI administration has demonstrated its definite effectiveness in prospective comparative trials, and controlling delayed bleeding remains an ongoing challenge. ESD for early gastric cancer is becoming increasingly widespread worldwide, and the demand for improving its safety is increasing. Further research, including prospective studies, is required to address the significant delayed bleeding complications of ESD. AUTHOR E.I. participated in the funded research of Takeda Pharmaceutical. E.I. has received a lecture fee from Takeda Pharmaceutical. The other authors declare that they have no conflicts of interest. None.
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- Type
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- Language
- en
- Landing Page
- https://doi.org/10.1111/den.14744
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/den.14744
- OA Status
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- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W4391144034Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1111/den.14744Digital Object Identifier
- Title
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Development of postoperative bleeding management in gastric endoscopic submucosal dissectionWork title
- Type
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editorialOpenAlex work type
- Language
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enPrimary language
- Publication year
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2024Year of publication
- Publication date
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2024-01-22Full publication date if available
- Authors
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Yusuke Suzuki, Mitsuru Esaki, Eikichi IharaList of authors in order
- Landing page
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https://doi.org/10.1111/den.14744Publisher landing page
- PDF URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/den.14744Direct link to full text PDF
- Open access
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
- OA URL
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/den.14744Direct OA link when available
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Medicine, Endoscopic submucosal dissection, Dissection (medical), General surgery, Surgery, RadiologyTop concepts (fields/topics) attached by OpenAlex
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0Total citation count in OpenAlex
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| best_oa_location.license_id | |
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| best_oa_location.is_published | True |
| best_oa_location.raw_source_name | Digestive Endoscopy |
| best_oa_location.landing_page_url | https://doi.org/10.1111/den.14744 |
| primary_location.id | doi:10.1111/den.14744 |
| primary_location.is_oa | True |
| primary_location.source.id | https://openalex.org/S192766619 |
| primary_location.source.issn | 0915-5635, 1443-1661 |
| primary_location.source.type | journal |
| primary_location.source.is_oa | False |
| primary_location.source.issn_l | 0915-5635 |
| primary_location.source.is_core | True |
| primary_location.source.is_in_doaj | False |
| primary_location.source.display_name | Digestive Endoscopy |
| primary_location.source.host_organization | https://openalex.org/P4310320595 |
| primary_location.source.host_organization_name | Wiley |
| primary_location.source.host_organization_lineage | https://openalex.org/P4310320595 |
| primary_location.license | |
| primary_location.pdf_url | https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/den.14744 |
| primary_location.version | publishedVersion |
| primary_location.raw_type | journal-article |
| primary_location.license_id | |
| primary_location.is_accepted | True |
| primary_location.is_published | True |
| primary_location.raw_source_name | Digestive Endoscopy |
| primary_location.landing_page_url | https://doi.org/10.1111/den.14744 |
| publication_date | 2024-01-22 |
| publication_year | 2024 |
| referenced_works | https://openalex.org/W4387662052, https://openalex.org/W2886411121, https://openalex.org/W3032934405, https://openalex.org/W1577087691, https://openalex.org/W2125781299, https://openalex.org/W2041435827, https://openalex.org/W2921508146, https://openalex.org/W4298121580, https://openalex.org/W2047249033, https://openalex.org/W1977204438 |
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| abstract_inverted_index.= | 247, 268, 278 |
| abstract_inverted_index.P | 246, 267, 277 |
| abstract_inverted_index.a | 33, 149, 287, 327, 354, 449, 624, 675, 683, 813, 845, 907, 958, 963, 1047 |
| abstract_inverted_index.h | 160 |
| abstract_inverted_index.48 | 159 |
| abstract_inverted_index.AC | 47, 89, 215, 233, 255, 839, 856 |
| abstract_inverted_index.As | 527 |
| abstract_inverted_index.In | 0, 37, 333, 448, 496, 716, 742 |
| abstract_inverted_index.an | 12, 528, 538, 996 |
| abstract_inverted_index.as | 128, 353, 507, 644, 738, 844 |
| abstract_inverted_index.at | 403, 867, 962 |
| abstract_inverted_index.be | 437, 519, 632, 892 |
| abstract_inverted_index.by | 169, 375, 719, 877, 905 |
| abstract_inverted_index.et | 7, 455, 535, 672, 721, 792 |
| abstract_inverted_index.if | 104 |
| abstract_inverted_index.in | 32, 45, 55, 66, 87, 174, 330, 392, 470, 523, 561, 568, 574, 613, 623, 635, 692, 750, 785, 812, 826, 987, 1037 |
| abstract_inverted_index.is | 286, 516, 590, 669, 709, 714, 789, 829, 897, 925, 957, 1004, 1016, 1023 |
| abstract_inverted_index.it | 515 |
| abstract_inverted_index.no | 223, 617, 689, 976, 1060 |
| abstract_inverted_index.of | 3, 203, 231, 261, 357, 379, 405, 486, 510, 564, 571, 611, 725, 733, 753, 765, 780, 799, 822, 849, 861, 870, 888, 917, 922, 929, 954, 1032, 1041, 1062 |
| abstract_inverted_index.on | 22, 424, 678, 803, 817 |
| abstract_inverted_index.or | 109, 131, 137, 154, 740, 835, 863 |
| abstract_inverted_index.s, | 98 |
| abstract_inverted_index.to | 18, 140, 183, 193, 199, 293, 412, 419, 518, 530, 551, 584, 592, 648, 899, 944, 972, 1025 |
| abstract_inverted_index.± | 219, 239, 243 |
| abstract_inverted_index.1.3 | 220 |
| abstract_inverted_index.242 | 252 |
| abstract_inverted_index.280 | 40, 43 |
| abstract_inverted_index.4.0 | 218 |
| abstract_inverted_index.40% | 732 |
| abstract_inverted_index.516 | 50, 53 |
| abstract_inverted_index.60% | 724 |
| abstract_inverted_index.ESD | 166, 344, 400, 491, 836, 875, 999 |
| abstract_inverted_index.Lee | 671, 720 |
| abstract_inverted_index.One | 627 |
| abstract_inverted_index.PGA | 555, 579, 612, 639, 657 |
| abstract_inverted_index.PPI | 980 |
| abstract_inverted_index.The | 206, 341, 360, 384, 703, 838, 851, 920, 1053 |
| abstract_inverted_index.al. | 8 |
| abstract_inverted_index.and | 14, 49, 82, 178, 234, 270, 301, 320, 326, 372, 390, 395, 444, 548, 581, 597, 604, 650, 700, 731, 757, 783, 934, 991, 1009 |
| abstract_inverted_index.are | 427, 557 |
| abstract_inverted_index.but | 566 |
| abstract_inverted_index.can | 291, 436, 891 |
| abstract_inverted_index.due | 198 |
| abstract_inverted_index.fee | 1049 |
| abstract_inverted_index.for | 96, 120, 195, 213, 298, 311, 401, 433, 629, 655, 665, 979, 1000, 1012 |
| abstract_inverted_index.has | 350, 408, 841, 982, 1045 |
| abstract_inverted_index.its | 984, 1014 |
| abstract_inverted_index.may | 492, 631, 936 |
| abstract_inverted_index.not | 559, 913 |
| abstract_inverted_index.the | 38, 46, 56, 63, 67, 88, 93, 113, 121, 141, 175, 185, 200, 204, 210, 214, 227, 232, 235, 254, 281, 296, 331, 377, 393, 413, 562, 609, 633, 638, 642, 645, 693, 698, 706, 717, 726, 734, 751, 771, 778, 804, 808, 820, 855, 859, 874, 915, 926, 938, 945, 952, 1010, 1027, 1038 |
| abstract_inverted_index.two | 440 |
| abstract_inverted_index.use | 916 |
| abstract_inverted_index.via | 884 |
| abstract_inverted_index.vs. | 241, 265, 275 |
| abstract_inverted_index.was | 100, 106, 126, 167, 191, 217 |
| abstract_inverted_index.(AC) | 16 |
| abstract_inverted_index.39.0 | 244 |
| abstract_inverted_index.39.5 | 240 |
| abstract_inverted_index.52.3 | 242 |
| abstract_inverted_index.E.I. | 1035, 1044 |
| abstract_inverted_index.ESD, | 62, 134, 148 |
| abstract_inverted_index.ESD. | 162, 950, 1033 |
| abstract_inverted_index.PEC. | 850 |
| abstract_inverted_index.Risk | 309 |
| abstract_inverted_index.Tang | 6 |
| abstract_inverted_index.This | 895 |
| abstract_inverted_index.Uedo | 454 |
| abstract_inverted_index.acid | 488, 500, 512, 545 |
| abstract_inverted_index.al., | 722 |
| abstract_inverted_index.al.4 | 456 |
| abstract_inverted_index.al.5 | 536 |
| abstract_inverted_index.al.8 | 673 |
| abstract_inverted_index.al.9 | 793 |
| abstract_inverted_index.also | 567 |
| abstract_inverted_index.been | 351, 409, 661, 748, 842, 970 |
| abstract_inverted_index.bias | 197 |
| abstract_inverted_index.does | 912 |
| abstract_inverted_index.drop | 151 |
| abstract_inverted_index.each | 380 |
| abstract_inverted_index.even | 520 |
| abstract_inverted_index.four | 367 |
| abstract_inverted_index.from | 112, 346, 1050 |
| abstract_inverted_index.g/dL | 153 |
| abstract_inverted_index.glue | 550, 589 |
| abstract_inverted_index.have | 478, 503, 607, 660, 747, 768, 969, 1059 |
| abstract_inverted_index.help | 593 |
| abstract_inverted_index.high | 763, 868 |
| abstract_inverted_index.into | 366, 439 |
| abstract_inverted_index.lead | 292 |
| abstract_inverted_index.made | 749 |
| abstract_inverted_index.min, | 221, 245 |
| abstract_inverted_index.more | 464, 521, 846, 908 |
| abstract_inverted_index.need | 297 |
| abstract_inverted_index.only | 560, 723 |
| abstract_inverted_index.over | 641 |
| abstract_inverted_index.pump | 460 |
| abstract_inverted_index.rate | 811 |
| abstract_inverted_index.risk | 335, 365, 404, 869, 928 |
| abstract_inverted_index.role | 573 |
| abstract_inverted_index.stop | 184 |
| abstract_inverted_index.than | 280, 466 |
| abstract_inverted_index.that | 11, 171, 209, 290, 458, 483, 710, 795, 854, 911, 1057 |
| abstract_inverted_index.them | 583 |
| abstract_inverted_index.they | 687, 1058 |
| abstract_inverted_index.this | 1, 630, 923, 955 |
| abstract_inverted_index.time | 211, 230 |
| abstract_inverted_index.used | 192, 558 |
| abstract_inverted_index.very | 373, 396 |
| abstract_inverted_index.were | 59, 69, 85, 118, 388, 463, 621, 728, 736 |
| abstract_inverted_index.when | 337, 942 |
| abstract_inverted_index.with | 42, 52, 222, 251, 318, 587, 705 |
| abstract_inverted_index.≥2 | 152 |
| abstract_inverted_index.(0.4% | 264 |
| abstract_inverted_index.(1.2% | 274 |
| abstract_inverted_index.(1:1) | 190 |
| abstract_inverted_index.(54.6 | 238 |
| abstract_inverted_index.(ESD) | 27 |
| abstract_inverted_index.(PEC) | 798 |
| abstract_inverted_index.(PGA) | 546 |
| abstract_inverted_index.(PPI) | 462 |
| abstract_inverted_index.11.4% | 389 |
| abstract_inverted_index.1–2 | 97 |
| abstract_inverted_index.29.7% | 391 |
| abstract_inverted_index.3.3%, | 266 |
| abstract_inverted_index.5.0%, | 276 |
| abstract_inverted_index.After | 61, 91, 249 |
| abstract_inverted_index.Based | 816 |
| abstract_inverted_index.Japan | 347 |
| abstract_inverted_index.None. | 1064 |
| abstract_inverted_index.These | 116 |
| abstract_inverted_index.Trend | 345 |
| abstract_inverted_index.Tsuji | 534 |
| abstract_inverted_index.Using | 578 |
| abstract_inverted_index.after | 133, 147, 161, 165, 343, 490 |
| abstract_inverted_index.aging | 414 |
| abstract_inverted_index.area. | 115 |
| abstract_inverted_index.being | 429 |
| abstract_inverted_index.blood | 158, 299, 865 |
| abstract_inverted_index.cases | 727, 735 |
| abstract_inverted_index.cover | 552 |
| abstract_inverted_index.early | 1001 |
| abstract_inverted_index.fecal | 156 |
| abstract_inverted_index.field | 563 |
| abstract_inverted_index.found | 208, 622, 688 |
| abstract_inverted_index.group | 48, 58, 256 |
| abstract_inverted_index.issue | 2 |
| abstract_inverted_index.large | 323 |
| abstract_inverted_index.layer | 947 |
| abstract_inverted_index.lower | 259 |
| abstract_inverted_index.model | 356 |
| abstract_inverted_index.other | 1054 |
| abstract_inverted_index.owing | 411 |
| abstract_inverted_index.rates | 260, 387, 696, 764 |
| abstract_inverted_index.risk. | 383 |
| abstract_inverted_index.score | 188, 349, 362 |
| abstract_inverted_index.sheet | 640, 646, 658 |
| abstract_inverted_index.signs | 177 |
| abstract_inverted_index.size, | 325 |
| abstract_inverted_index.study | 207, 677, 718, 956 |
| abstract_inverted_index.tends | 647 |
| abstract_inverted_index.their | 572 |
| abstract_inverted_index.there | 105 |
| abstract_inverted_index.these | 781, 818 |
| abstract_inverted_index.total | 228 |
| abstract_inverted_index.tumor | 324, 328 |
| abstract_inverted_index.ulcer | 68, 143, 680, 805, 828 |
| abstract_inverted_index.using | 72, 102, 543, 682, 832 |
| abstract_inverted_index.vital | 176 |
| abstract_inverted_index.whole | 122 |
| abstract_inverted_index.0.032) | 279 |
| abstract_inverted_index.0.037) | 269 |
| abstract_inverted_index.AUTHOR | 1034 |
| abstract_inverted_index.BSET-J | 361 |
| abstract_inverted_index.Takeda | 1042, 1051 |
| abstract_inverted_index.Tokyo, | 78 |
| abstract_inverted_index.active | 107, 135 |
| abstract_inverted_index.cancer | 1003 |
| abstract_inverted_index.caused | 172 |
| abstract_inverted_index.damage | 937, 943 |
| abstract_inverted_index.demand | 1011 |
| abstract_inverted_index.detach | 651 |
| abstract_inverted_index.during | 144, 873, 949 |
| abstract_inverted_index.except | 978 |
| abstract_inverted_index.fibrin | 549, 588 |
| abstract_inverted_index.funded | 1039 |
| abstract_inverted_index.group. | 90, 283 |
| abstract_inverted_index.groups | 237 |
| abstract_inverted_index.kidney | 316 |
| abstract_inverted_index.layer, | 940 |
| abstract_inverted_index.manage | 420 |
| abstract_inverted_index.melena | 132 |
| abstract_inverted_index.method | 542, 774, 848, 896, 924, 977 |
| abstract_inverted_index.muscle | 939, 946 |
| abstract_inverted_index.nature | 202 |
| abstract_inverted_index.needle | 758 |
| abstract_inverted_index.occult | 157 |
| abstract_inverted_index.occurs | 948 |
| abstract_inverted_index.pairs, | 253 |
| abstract_inverted_index.points | 378, 887 |
| abstract_inverted_index.proton | 459 |
| abstract_inverted_index.reason | 628 |
| abstract_inverted_index.recent | 497, 743 |
| abstract_inverted_index.reduce | 598 |
| abstract_inverted_index.repair | 594 |
| abstract_inverted_index.safety | 1015 |
| abstract_inverted_index.sheets | 547, 556, 580 |
| abstract_inverted_index.shock, | 295 |
| abstract_inverted_index.showed | 257 |
| abstract_inverted_index.single | 964 |
| abstract_inverted_index.snare. | 685 |
| abstract_inverted_index.strong | 484 |
| abstract_inverted_index.study, | 39 |
| abstract_inverted_index.study. | 36, 205, 815 |
| abstract_inverted_index.suture | 755 |
| abstract_inverted_index.target | 94 |
| abstract_inverted_index.tissue | 95, 540, 576 |
| abstract_inverted_index.trial, | 453 |
| abstract_inverted_index.ulcer, | 643 |
| abstract_inverted_index.ulcers | 28, 586, 596, 668 |
| abstract_inverted_index.years, | 498, 744 |
| abstract_inverted_index.(2023)1 | 9 |
| abstract_inverted_index.(H2RAs) | 469 |
| abstract_inverted_index.(ROLM). | 775 |
| abstract_inverted_index.0.435). | 248 |
| abstract_inverted_index.Another | 663 |
| abstract_inverted_index.Further | 776, 1018 |
| abstract_inverted_index.Japan). | 79 |
| abstract_inverted_index.Massive | 163 |
| abstract_inverted_index.Several | 474, 653 |
| abstract_inverted_index.adapted | 119 |
| abstract_inverted_index.address | 1026 |
| abstract_inverted_index.authors | 852, 1055 |
| abstract_inverted_index.because | 570, 931 |
| abstract_inverted_index.between | 226, 697 |
| abstract_inverted_index.center. | 965 |
| abstract_inverted_index.changes | 173 |
| abstract_inverted_index.chronic | 315 |
| abstract_inverted_index.closed, | 730 |
| abstract_inverted_index.closure | 681, 699, 707, 713 |
| abstract_inverted_index.control | 57, 236, 282 |
| abstract_inverted_index.crumple | 649 |
| abstract_inverted_index.damaged | 864 |
| abstract_inverted_index.declare | 1056 |
| abstract_inverted_index.defined | 127 |
| abstract_inverted_index.delayed | 425, 871, 889, 974, 993, 1029 |
| abstract_inverted_index.devices | 756, 782 |
| abstract_inverted_index.disease | 317 |
| abstract_inverted_index.easily. | 652 |
| abstract_inverted_index.effects | 620 |
| abstract_inverted_index.efforts | 418 |
| abstract_inverted_index.enables | 858 |
| abstract_inverted_index.exposed | 110 |
| abstract_inverted_index.factors | 310, 339 |
| abstract_inverted_index.failed. | 741 |
| abstract_inverted_index.forceps | 74, 103, 834 |
| abstract_inverted_index.fragile | 862 |
| abstract_inverted_index.gastric | 487, 511, 1002 |
| abstract_inverted_index.groups, | 398 |
| abstract_inverted_index.groups. | 702 |
| abstract_inverted_index.improve | 901 |
| abstract_inverted_index.include | 314 |
| abstract_inverted_index.lecture | 1048 |
| abstract_inverted_index.lesions | 44, 54 |
| abstract_inverted_index.massive | 262 |
| abstract_inverted_index.methods | 904 |
| abstract_inverted_index.ongoing | 997 |
| abstract_inverted_index.overall | 271 |
| abstract_inverted_index.patient | 307, 415 |
| abstract_inverted_index.prevent | 493, 973 |
| abstract_inverted_index.problem | 704 |
| abstract_inverted_index.reduced | 29, 807 |
| abstract_inverted_index.remains | 995 |
| abstract_inverted_index.repair. | 577 |
| abstract_inverted_index.require | 914 |
| abstract_inverted_index.several | 602 |
| abstract_inverted_index.similar | 480 |
| abstract_inverted_index.studies | 606, 968 |
| abstract_inverted_index.study.6 | 626 |
| abstract_inverted_index.suction | 114, 933 |
| abstract_inverted_index.summing | 376 |
| abstract_inverted_index.surface | 806 |
| abstract_inverted_index.sutures | 767 |
| abstract_inverted_index.through | 881 |
| abstract_inverted_index.trials, | 990 |
| abstract_inverted_index.ulcers, | 533 |
| abstract_inverted_index.ulcers. | 123, 447, 554 |
| abstract_inverted_index.vessels | 21, 65, 111, 802, 825, 866 |
| abstract_inverted_index.visible | 64, 800, 823 |
| abstract_inverted_index.(BSET-J) | 348 |
| abstract_inverted_index.(P-cabs) | 502 |
| abstract_inverted_index.Although | 601, 966 |
| abstract_inverted_index.Bleeding | 342 |
| abstract_inverted_index.However, | 686 |
| abstract_inverted_index.Olympus, | 77 |
| abstract_inverted_index.Takizawa | 791 |
| abstract_inverted_index.actively | 428 |
| abstract_inverted_index.adhering | 582 |
| abstract_inverted_index.advanced | 847 |
| abstract_inverted_index.analysis | 960 |
| abstract_inverted_index.approach | 529, 664, 910 |
| abstract_inverted_index.attached | 139 |
| abstract_inverted_index.becoming | 1005 |
| abstract_inverted_index.bleeding | 31, 108, 125, 170, 273, 285, 313, 364, 382, 386, 407, 435, 695, 788, 810, 872, 880, 890, 994, 1030 |
| abstract_inverted_index.blockers | 501 |
| abstract_inverted_index.closure. | 670 |
| abstract_inverted_index.complete | 712, 766 |
| abstract_inverted_index.critical | 288 |
| abstract_inverted_index.definite | 985 |
| abstract_inverted_index.devices. | 837, 919 |
| abstract_inverted_index.efficacy | 610, 779 |
| abstract_inverted_index.emerged, | 769 |
| abstract_inverted_index.expected | 517, 591, 898 |
| abstract_inverted_index.focusing | 423 |
| abstract_inverted_index.forceps. | 759 |
| abstract_inverted_index.inducing | 879 |
| abstract_inverted_index.location | 329 |
| abstract_inverted_index.matching | 189, 250 |
| abstract_inverted_index.multiple | 338 |
| abstract_inverted_index.numerous | 967 |
| abstract_inverted_index.patients | 41, 51, 402 |
| abstract_inverted_index.physical | 882 |
| abstract_inverted_index.positive | 155 |
| abstract_inverted_index.post-ESD | 446, 532, 553, 585, 595, 667, 679, 796, 827 |
| abstract_inverted_index.proposed | 352, 853 |
| abstract_inverted_index.received | 1046 |
| abstract_inverted_index.reported | 10, 457, 479, 537, 794 |
| abstract_inverted_index.required | 212, 1024 |
| abstract_inverted_index.research | 1040 |
| abstract_inverted_index.residual | 20, 801, 824 |
| abstract_inverted_index.results, | 481, 819 |
| abstract_inverted_index.studies, | 475, 1022 |
| abstract_inverted_index.suction. | 885 |
| abstract_inverted_index.surgery, | 565 |
| abstract_inverted_index.therapy, | 322 |
| abstract_inverted_index.thrombus | 138 |
| abstract_inverted_index.treating | 666 |
| abstract_inverted_index.yielding | 762 |
| abstract_inverted_index.Digestive | 4 |
| abstract_inverted_index.FD-410LR, | 76 |
| abstract_inverted_index.Potential | 886 |
| abstract_inverted_index.achieving | 711 |
| abstract_inverted_index.addition, | 334 |
| abstract_inverted_index.affecting | 306 |
| abstract_inverted_index.assisting | 575 |
| abstract_inverted_index.attention | 506 |
| abstract_inverted_index.attracted | 504 |
| abstract_inverted_index.bleeding, | 136, 426, 616, 975 |
| abstract_inverted_index.bleeding. | 186, 473, 495, 526, 600 |
| abstract_inverted_index.challenge | 634 |
| abstract_inverted_index.coincide. | 340 |
| abstract_inverted_index.conducted | 674, 961, 971 |
| abstract_inverted_index.conflicts | 1061 |
| abstract_inverted_index.developed | 843 |
| abstract_inverted_index.effective | 465, 522 |
| abstract_inverted_index.efficient | 909 |
| abstract_inverted_index.emergency | 145, 180, 302 |
| abstract_inverted_index.endoscopy | 146, 569 |
| abstract_inverted_index.enrolled. | 60 |
| abstract_inverted_index.excessive | 932 |
| abstract_inverted_index.high-risk | 374, 394, 397 |
| abstract_inverted_index.improving | 1013 |
| abstract_inverted_index.including | 476, 770, 1020 |
| abstract_inverted_index.increases | 336 |
| abstract_inverted_index.interest. | 1063 |
| abstract_inverted_index.low-risk, | 369 |
| abstract_inverted_index.performed | 86, 101, 831 |
| abstract_inverted_index.placement | 659 |
| abstract_inverted_index.potential | 196, 508, 927 |
| abstract_inverted_index.procedure | 216, 229, 876 |
| abstract_inverted_index.providing | 906 |
| abstract_inverted_index.research, | 1019 |
| abstract_inverted_index.routinely | 70, 830 |
| abstract_inverted_index.secretion | 489 |
| abstract_inverted_index.shielding | 541 |
| abstract_inverted_index.suggested | 608 |
| abstract_inverted_index.targeting | 442, 445, 531 |
| abstract_inverted_index.technique | 17, 708, 840, 857 |
| abstract_inverted_index.visualize | 19 |
| abstract_inverted_index.Additional | 80 |
| abstract_inverted_index.Endoscopy, | 5 |
| abstract_inverted_index.Propensity | 187 |
| abstract_inverted_index.Therefore, | 514 |
| abstract_inverted_index.additional | 918 |
| abstract_inverted_index.approaches | 432 |
| abstract_inverted_index.artificial | 142 |
| abstract_inverted_index.aspirating | 92 |
| abstract_inverted_index.aspiration | 13, 81 |
| abstract_inverted_index.bleeding.3 | 359 |
| abstract_inverted_index.challenge. | 998 |
| abstract_inverted_index.classified | 438, 737 |
| abstract_inverted_index.classifies | 363 |
| abstract_inverted_index.coagulated | 71, 893 |
| abstract_inverted_index.compensate | 194 |
| abstract_inverted_index.completely | 729 |
| abstract_inverted_index.controlled | 452 |
| abstract_inverted_index.desirable. | 790 |
| abstract_inverted_index.detachable | 684 |
| abstract_inverted_index.difference | 225, 691 |
| abstract_inverted_index.dissection | 26 |
| abstract_inverted_index.endoscopic | 24, 181, 539, 754 |
| abstract_inverted_index.especially | 941 |
| abstract_inverted_index.hemoglobin | 150 |
| abstract_inverted_index.hemorrhage | 164, 263 |
| abstract_inverted_index.hemostatic | 73, 303, 833 |
| abstract_inverted_index.high-risk, | 371 |
| abstract_inverted_index.incomplete | 739 |
| abstract_inverted_index.inhibition | 485 |
| abstract_inverted_index.inhibitors | 461, 509 |
| abstract_inverted_index.limitation | 921, 953 |
| abstract_inverted_index.nonsutured | 701 |
| abstract_inverted_index.outcomes.2 | 308 |
| abstract_inverted_index.predictive | 355 |
| abstract_inverted_index.preventing | 471, 524, 614, 786 |
| abstract_inverted_index.preventive | 619 |
| abstract_inverted_index.randomized | 451 |
| abstract_inverted_index.reopenable | 772 |
| abstract_inverted_index.reported.7 | 662 |
| abstract_inverted_index.secretion. | 513 |
| abstract_inverted_index.submucosal | 25 |
| abstract_inverted_index.suggesting | 482 |
| abstract_inverted_index.supporting | 656 |
| abstract_inverted_index.techniques | 84, 117, 654, 761, 784 |
| abstract_inverted_index.therefore, | 417 |
| abstract_inverted_index.widespread | 1007 |
| abstract_inverted_index.worldwide, | 1008 |
| abstract_inverted_index.H2-receptor | 467 |
| abstract_inverted_index.antagonists | 468 |
| abstract_inverted_index.categories: | 368, 441 |
| abstract_inverted_index.coagulation | 15, 83, 99, 797, 821, 903, 935 |
| abstract_inverted_index.comparative | 989 |
| abstract_inverted_index.controlling | 992 |
| abstract_inverted_index.development | 752 |
| abstract_inverted_index.effectively | 636 |
| abstract_inverted_index.hemorrhagic | 294 |
| abstract_inverted_index.increasing, | 410 |
| abstract_inverted_index.increasing. | 1017 |
| abstract_inverted_index.medications | 443 |
| abstract_inverted_index.perforation | 930 |
| abstract_inverted_index.population; | 416 |
| abstract_inverted_index.positioning | 637 |
| abstract_inverted_index.postgastric | 23 |
| abstract_inverted_index.prospective | 450, 625, 676, 988, 1021 |
| abstract_inverted_index.researched. | 430 |
| abstract_inverted_index.significant | 224, 618, 690, 745, 1028 |
| abstract_inverted_index.stimulation | 883 |
| abstract_inverted_index.(Coagrasper; | 75 |
| abstract_inverted_index.Prophylactic | 431 |
| abstract_inverted_index.advancements | 746 |
| abstract_inverted_index.challenging. | 715 |
| abstract_inverted_index.complication | 289 |
| abstract_inverted_index.considerable | 505 |
| abstract_inverted_index.conventional | 902 |
| abstract_inverted_index.demonstrated | 983 |
| abstract_inverted_index.hematemesis, | 129 |
| abstract_inverted_index.hemodialysis | 319 |
| abstract_inverted_index.increasingly | 1006 |
| abstract_inverted_index.intervention | 182 |
| abstract_inverted_index.lower-third. | 332 |
| abstract_inverted_index.necessitated | 179 |
| abstract_inverted_index.participated | 1036 |
| abstract_inverted_index.polyglycolic | 544 |
| abstract_inverted_index.Additionally, | 951 |
| abstract_inverted_index.Consequently, | 760 |
| abstract_inverted_index.Postoperative | 124, 284 |
| abstract_inverted_index.anticoagulant | 321 |
| abstract_inverted_index.characterized | 168 |
| abstract_inverted_index.complications | 1031 |
| abstract_inverted_index.effectiveness | 986 |
| abstract_inverted_index.hematochezia, | 130 |
| abstract_inverted_index.intentionally | 878 |
| abstract_inverted_index.investigating | 777 |
| abstract_inverted_index.meta-analyses | 603 |
| abstract_inverted_index.postoperative | 30, 272, 312, 358, 381, 385, 406, 434, 472, 494, 525, 599, 615, 694, 787, 809 |
| abstract_inverted_index.respectively. | 399 |
| abstract_inverted_index.retrospective | 35, 201, 605, 814, 959 |
| abstract_inverted_index.significantly | 258, 305, 900 |
| abstract_inverted_index.single-center | 34 |
| abstract_inverted_index.transfusions, | 300 |
| abstract_inverted_index.ESD-associated | 421 |
| abstract_inverted_index.administration | 981 |
| abstract_inverted_index.complications, | 422 |
| abstract_inverted_index.identification | 860 |
| abstract_inverted_index.interventions, | 304 |
| abstract_inverted_index.meta-analyses, | 477 |
| abstract_inverted_index.Pharmaceutical. | 1043, 1052 |
| abstract_inverted_index.prophylactically. | 894 |
| abstract_inverted_index.clip-over-the-line | 773 |
| abstract_inverted_index.intermediate-risk, | 370 |
| abstract_inverted_index.potassium-competitive | 499 |
| cited_by_percentile_year | |
| corresponding_author_ids | https://openalex.org/A5000221599 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 3 |
| corresponding_institution_ids | https://openalex.org/I135598925, https://openalex.org/I4210143502 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/2 |
| sustainable_development_goals[0].score | 0.75 |
| sustainable_development_goals[0].display_name | Zero hunger |
| citation_normalized_percentile.value | 0.01654055 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |