Risk factors for bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm.

Abstract

BACKGROUND:

Although endoscopic submucosal dissection (ESD) is standard therapy in Japan for gastric epithelial neoplasm, the complication rate is unsatisfactory, with postoperative bleeding as the major complication. The aim of the present study was to determine risk factors for post-ESD bleeding in patients with gastric epithelial neoplasm.

PATIENTS AND METHODS:

The study included 764 patients in whom 924 gastric epithelial neoplasms were resected endoscopically between June 2005 and December 2009: the period during which preventative coagulation for all exposed vessels on the artificial ulcer with hemostatic forceps upon completion of ESD was performed routinely. We analyzed the risk factors for bleeding after ESD in relation to the various clinical factors.

RESULTS:

The post-ESD bleeding rate was 3.0%. Dialysis (vs no dialysis, P = 0.034), operation time ≥75 min (vs <75 min, P = 0.012) and poor control of bleeding during ESD (vs good control, P = 0.014) were significantly related to post-ESD bleeding. Poor control of bleeding during ESD (vs good control; P = 0.04) and operation time ≥75 min (vs <75 min; P = 0.012) were significantly related to bleeding after second-look endoscopy.

CONCLUSIONS:

Patients at high risk for post-ESD bleeding in gastric epithelial neoplasm were those undergoing dialysis, those in whom operation time was ≥75 min, and those in whom bleeding during ESD was poorly controlled. The latter two are risk factors for bleeding even after second-look endoscopy.

• Authors: Makoto Higashiyama, Shiro Oka, Shinji Tanaka, Yoji Sanomura, Hiroki Imagawa, Takayoshi Shishido, Shigeto Yoshida, Kazuaki Chayama
• Journal: Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society (Dig Endosc) Vol. 23 Issue 4 Pg. 290-5 (Oct 2011) ISSN: 1443-1661 [Electronic] Australia
• PMID: 21951088 (Publication Type: Journal Article)
• Copyright: © 2011 The Authors. Digestive Endoscopy © 2011 Japan Gastroenterological Endoscopy Society.

Topics

• Adult
• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Comorbidity
• Dissection
• Female
• Gastric Mucosa (surgery)
• Gastroscopy (methods)
• Hemorrhage (epidemiology, prevention & control)
• Hemostasis, Surgical (methods)
• Humans
• Japan (epidemiology)
• Male
• Middle Aged
• Postoperative Complications (epidemiology, prevention & control)
• Renal Dialysis
• Risk Factors
• Second-Look Surgery
• Stomach Neoplasms (surgery)
• Time Factors