Endoscopic submucosal dissection (ESD) is now considered a standard treatment for selected patients with early
gastric cancer. Compared with endoscopic mucosal resection (EMR), ESD provides a higher complete resection rate (R0), and therefore, a lower local recurrence rate. However, ESD is a more time-consuming procedure, creating a wider and deeper
ulcer floor which may cause complications. Post-ESD
bleeding is one of them. Although most post-ESD bleedings can be controlled by
endoscopic hemostasis at the time of operation, some
bleeding after ESD may result in serious conditions such as
hemorrhagic shock. Even with preventive methods such as
ulcer closure, the application of
fibrin glue and
polyglycolic acid shielding,
acid secretion inhibitors and hemostasis on second-look endoscopy, our experiences told us that post-ESD
bleeding cannot be entirely avoidable, especially for patients with big size
ulcer bed,
anticoagulants/antithrombosis and
chronic kidney diseases. The present review first defined post-ESD
bleeding, then the incidence, the risk factors, such as the location of operative lesion, the size and depth,
chronic kidney diseases, the impacts of
anticoagulant and
antithrombotic agents. We finally reviewed the managements of post-ESD
bleeding, including approaches of coagulating potential
bleeding spots during the procedure, lesion closure, lesion shielding and the application of gastric acid secretion inhibitors.