Different clinical characteristics associated with acute bleeding and delayed bleeding after endoscopic submucosal dissection in patients with early gastric cancer

Yano, Takafumi; Tanabe, Satoshi; Ishido, Kenji; Suzuki, Mizuto; Kawanishi, Natsuko; Yamane, Sakiko; Watanabe, Akinori; Wada, Takuya; Azuma, Mizutomo; Katada, Chikatoshi; Koizumi, Wasaburo

doi:10.1007/s00464-017-5513-1

Cited by 45 publications

(62 citation statements)

References 34 publications

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“…As shown in Table , many studies have reported the risk factors of bleeding after ESD of gastric lesions . Based on the current research results, the risk factors can be classified into patient‐, tumor‐ and operation‐related factors.…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 97%

“…Hemorrhage is the most severe postoperative complication associated with ESD. However, no consensus has so far been reached on the definitions of post‐ESD bleeding, leading to different rates of post‐ESD bleeding in previous studies ranging from 1.3% to 13.0% …”

Section: Bleeding After Gastric Esdmentioning

confidence: 99%

“…Therefore, it is essential to evaluate the association between bleeding risk and thromboembolism when antithrombotic drugs are being administered. Some studies reported that use of antithrombotic drug was a risk factor for hemorrhage after gastric ESD . Conversely, others showed that antithrombotic drugs did not increase such risk .…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

“…Some studies have reported that long operation time increases the incidence of post‐ESD hemorrhage . Libânio et al reported that the operation time over 60 minutes was related to an increased incidence of post‐ESD bleeding of gastric lesions.…”

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

“…However, no consensus has so far been reached on the definitions of post-ESD bleeding, leading to different rates of post-ESD bleeding in previous studies ranging from 1.3% to 13.0%. 1,[7][8][9][10][11][12][13][14][15] The most common definition of post-ESD bleeding is hemorrhage occurs within 4 weeks after ESD that presents as hematemesis, melena or hematochezia, and/or a decrease in hemoglobin level by ≥20 g/L and unstable hemodynamics. 11 In some studies post-ESD bleeding is further divided into early (within 48 h after ESD) and late hemorrhage (more than 48 h after ESD) according to the occurrence time of bleeding.…”

Section: Bleeding After Gastric Esdmentioning

confidence: 99%

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Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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Endoscopic submucosal dissection (ESD) is generally used to treat gastric mucosal and submucosal lesions. Nevertheless, ESD is more difficult and complicated to perform than a traditional endoscopic mucosal resection, which can increase the incidence of various complications including hemorrhage, perforation and infection. Hemorrhage is a major post‐ESD complication. Prevention and early diagnosis of post‐ESD bleeding for gastric lesions are closely associated with the efficacy and safety of the operation. Many studies have reported the risks of and the preventative measures for hemorrhage after gastric ESD, but there remain some issues to be solved. We thus reviewed the risk factors, precautions and treatments for hemorrhage after ESD of gastric lesions.

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Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 97%

Section: Bleeding After Gastric Esdmentioning

confidence: 99%

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

Section: Risks Of Bleeding After Gastric Esdmentioning

confidence: 99%

Section: Bleeding After Gastric Esdmentioning

confidence: 99%

See 3 more Smart Citations

Bleeding after endoscopic submucosal dissection of gastric lesions

Yang

Qiu

et al. 2020

J of Digest Diseases

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Establishment of a swine model of delayed bleeding after endoscopic procedure

Uehara,

Sasaki,

Sahara

et al. 2024

DEN Open

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ObjectivesAlthough delayed bleeding after endoscopic procedures has become a problem, currently, there are no appropriate animal models to validate methods for preventing it. This study aimed to establish an animal model of delayed bleeding after endoscopic procedures of the gastrointestinal tract.MethodsActivated coagulation time (ACT) was measured using blood samples drawn from a catheter inserted into the external jugular vein of swine (n = 7; age, 6 months; mean weight, 13.8 kg) under general anesthesia using the cut‐down method. An upper gastrointestinal endoscope was inserted orally, and 12 mucosal defects were created in the stomach by endoscopic mucosal resection using a ligating device. Hemostasis was confirmed at this time point. The heparin group (n = 4) received 50 units/kg of unfractionated heparin via a catheter; after confirming that the ACT was ≥200 s 10 min later, continuous heparin administration (50 units/kg/h) was started. After 24 h, an endoscope was inserted under general anesthesia to evaluate the blood volume in the stomach and the degree of blood adherence at the site of the mucosal defect.ResultsDelayed bleeding was observed in three swine (75%) in the heparin‐treated group, who had a maximum ACT of >220 s before the start of continuous heparin administration. In the non‐treated group (n = 3), no prolonged ACT or delayed bleeding was observed at 24 h.ConclusionAn animal model of delayed bleeding after an endoscopic procedure in the gastrointestinal tract was established using a single dose of heparin and continuous heparin administration after confirming an ACT of 220 s.

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Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

et al. 2021

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Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction‐assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST‐J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.

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Different clinical characteristics associated with acute bleeding and delayed bleeding after endoscopic submucosal dissection in patients with early gastric cancer

Abstract: Acute post-ESD bleeding and delayed post-ESD bleeding were associated with different clinical characteristics. Antithrombotic therapy is a risk factor for post-ESD bleeding in both the acute and delayed phases.

Cited by 45 publications

References 34 publications

Bleeding after endoscopic submucosal dissection of gastric lesions

Bleeding after endoscopic submucosal dissection of gastric lesions

Establishment of a swine model of delayed bleeding after endoscopic procedure

Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

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