Analysis of Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Epithelial Neoplasms

Abstract

Aim. Delayed bleeding after endoscopic submucosal dissection (ESD) for gastric epithelial neoplasms is a major complication. We investigated factors related to post-ESD bleeding to identify preventive measures. Methods. The study included 161 gastric epithelial neoplasms in 142 patients from June 2007 to September 2010. Post-ESD bleeding was defined as an ulcer with active bleeding or apparent exposed vessels diagnosed by an emergency endoscopy or a planned follow-up endoscopy. We analyzed associations between bleeding and the following factors: age, sex, morphology, pathology, tumor depth, ulcer presence/absence, location, size of the resected lesion, duration of the procedure, the number of times bleeding occurred during ESD, and the use of anticoagulants and/or antiplatelet drugs. Subsequently, we examined characteristics of bleeding cases. Results. Post-ESD bleeding occurred in 21 lesions. Univariate analysis of these cases showed that ulcer presence/absence (P < 0.001), middle or lower third lesions (P = 0.036), circumference (P = 0.014), and a post-ESD ulcer with an extended lesser curve (P = 0.009) were significant predictors of bleeding. Multivariate analysis showed that ulcer presence/absence (OR 9.73, 95% CI 2.28–41.53) was the only significant predictor. Conclusion. Ulcer presence/absence was considered the most significant predictor of post-ESD bleeding.

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

“…34 Furthermore, 10 studies found no significant differences in elderly patients, 19,25,30,[35][36][37][38][39][40][41] although 1 study identified age > 80 years as an independent risk factor for PPB. 42 PPB rates were similar between genders in most studies, [13][14][15][16][17][18][20][21][22][23][25][26][27][28][29][30][31][32][33][34]36,39,[42][43][44] with only 1 study reporting an association male sex associated with PPB. 24 Arterial hypertension was not identified as a risk factor in most studies, [13][14][15]17,18,[20][21][22][23][24][28]…”

“…48 After meta-analysis, male sex, cardiopathy, cirrhosis, and chronic kidney disease were significantly associated with PPB. Among patients with chronic kidney disease, dialysis was associated with an increased PPB risk ( 16,27,35,52,53,56,75 did not clearly report AT management (pooled PPB, 3.6%), whereas this was adequately reported in the remaining studies.…”

“…13,14,[16][17][18][20][21][22][23][27][28][29][30][31]36,42,43 However, meta-analysis showed that PPB was significantly associated with AT use (Fig. 3).…”

“…When the studies evaluated the mean sizes of tumors and resected specimens between those with PPB and those without, the results were conflicting, with some reporting significant differences between tumor 22,26,34,42 and specimen 21,23,24,29,34,42 sizes and others not finding significant differences between the 2 groups. 13,14,[16][17][18]20,27,28,[31][32][33]51 In addition, results concerning whether tumor location impacts PPB were controversial. Four studies reported that tumors located in the lower third 33,34,36,57 and in the middle/lower third 27,31,37,38 of the stomach had significantly higher bleeding rates, whereas the upper location of the stomach was found to be a significant risk factor in other studies.…”

Continued use of low-dose aspirin may increase risk of bleeding after gastrointestinal endoscopic submucosal dissection: A meta-analysis

“…Some studies reported that bleeding was associated with lesion size and tumor location; for example, the hazard of post-ESD bleeding was higher when the lesions were located in the cecum, but it was difficult to stratify patients by these factors in our meta-analysis (31,32). There were also some unanswered questions regarding the bleeding of post-ESD and aspirin use.…”