Bleeding Risk Factors after Endoscopic Submucosal Dissection in Early Gastric Cancer and the Necessity of “Second-Look” Endoscopic Examination on the following Day

Abstract

Background and Aim: Hemorrhage is often encountered after endoscopic submucosal dissection (ESD). In addition to active bleeding after resection, exposed blood vessels and blood clots without active bleeding on the post-dissection ulcer floor have been recognized within our department. We consider exposed and/or observable vessel findings and clots on the ulcer floor after re-section as important risk factors for hemorrhage. Here, we compared and examined the active bleeding frequency and “post-resection ulcer at risk of bleeding” on the day following ESD, in relation to their risk factors. Method: We retrospectively examined 447 patients who underwent second-look endoscopy in our department between August 2008 and March 2018. Logistic regression analyses were performed to determine the hazard ratio and 95% confidence interval. We compared the association of each factor mentioned above with active bleeding on the day after ESD and the presence of ulcers at risk of bleeding after resection. Results: Our retrospective analysis revealed that the risk factors were larger ulcer sizes and the administration of antithrombotic drugs. Additionally, the risk was low for upper body lesions but high for antral lesions. Conclusion: Our results may help determine whether second-look endoscopy should be performed to minimize active bleeding after ESD, reduce postoperative complications, and improve medical safety.

Risk factors for postoperative bleeding following endoscopic submucosal dissection in early gastric cancer: A systematic review and meta-analysis

“…These findings underscore the importance of meticulous surgical planning and patient management in EGC treatment. [ 21 ] They also highlight the need for further research into optimizing surgical techniques and postoperative care to minimize complications, particularly in patients requiring extensive resections or with clinical comorbidities such as hypertension.…”

Aspiration and coagulation to reduce risk of delayed bleeding after gastric endoscopic submucosal dissection (with video)

“…The endoscopic submucosal dissection (ESD) technique was developed to extend the ability of endoscopic mucosal resection to remove lesions larger than 2 cm en bloc, albeit requiring additional technical skills, prolonged operative time, and including increased adverse events such as bleeding and perforation compared with endoscopic mucosal resection. Delayed bleeding is the most common complication after ESD, 1 occurring in 4.1% to 11.8% of patients undergoing gastric ESD 2–5 . Various factors, 6 including male gender, comorbidities, 7 tumor characteristics, 1,8,9 long‐term dialysis, 10 and antithrombotic drugs have been identified to be associated with bleeding after gastric ESD 11,12 .…”