Evidence map›Paper›PMID 40820412›Full record

ArticleDigestion2026

Dialysis, Antithrombotics, and Lesion Location: Who Benefits Most from Gel Immersion Endoscopy in Gastric Endoscopic Submucosal Dissection?

Hiroki Hayashi, Takeshi Kanno, Tomonori Yano, Kazuaki Akahoshi, Jun Owada, Hiromi Sekiguchi, Takashi Ueno, Yoshie Nomoto, Hisashi Fukuda, Haruo Takahashi and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Digestion, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Hiroki HayashiDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Takeshi KannoR & D Division of Career Education for Medical Professionals, Medical Education Center, Jichi Medical University, Shimotsuke, Japan, kanno.takeshi@med.tohoku.ac.jp.
Tomonori YanoDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Kazuaki AkahoshiDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Jun OwadaDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Hiromi SekiguchiDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Takashi UenoDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Yoshie NomotoDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Hisashi FukudaDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Haruo TakahashiDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Yuji InoDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Hironori YamamotoDivision of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

<p>Introduction: Gel immersion endoscopy (GIE) is a technique used to maintain a clear view during gastric endoscopic submucosal dissection. We aimed to identify cases most likely to benefit from GIE for ESD bleeding by reviewing our clinical experience and determining the associated factors.

methodsWe retrospectively analyzed 470 lesions in 380 patients who underwent gastric ESD between October 2020 and March 2023. The patients were divided into conventional method (n = 433) and GIE groups (n = 37). We compared the clinical and pathological characteristics between the groups. Univariate and multivariate logistic regression analyses were used to identify factors associated with GIE use. Among the GIE group, hemostasis times under gas, water, and gel conditions were compared using the Kruskal-Wallis test.

resultsMultivariate analysis revealed that dialysis (odds ratio [OR]: 15.3), concurrent antiplatelet and anticoagulant use (OR: 9.5), and tumor location in the middle third (OR: 3.5), upper third (OR: 5.7), or remnant stomach (OR: 9.3) were independently associated with GIE use. No significant differences in overall hemostasis time were observed between gas, water, or gel. Of the nine bleeding events exceeding 300 s under gas immersion, seven achieved successful hemostasis by switching to GIE, with a median of 32 s to locate the source and 140 s to complete hemostasis.

conclusionDialysis, combined antithrombotic use, and certain tumor locations were key factors influencing GIE for ESD bleeding. Although the overall hemostasis times did not differ, GIE may be particularly beneficial in high-risk scenarios. </p>.

Indexed as

Blood Loss, SurgicalEndoscopic Mucosal ResectionFibrinolytic AgentsGastrointestinal HemorrhageGastroscopyRenal DialysisStomach NeoplasmsAgedAged, 80 and overFemaleGastric MucosaHumansMaleMiddle AgedRetrospective StudiesRisk FactorsFibrinolytic AgentsGel immersion endoscopyIntraoperative bleedingStomachSubmucosal dissection

Identifiers

PMID40820412
PMCPMC12503684

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.