Renal dysfunction is an independent risk factor for bleeding after gastric ESD

Abstract

Background and study aims: The number of patients with chronic kidney disease (CKD) is increasing worldwide and gastric cancer sometimes occurs with CKD. However, the safety and feasibility of endoscopic submucosal dissection (ESD) for patients with CKD are not clear. The aim of this study is to clarify the feasibility and safety of gastric ESD for patients with CKD. Patients and methods: This was a multicenter retrospective cohort study. In total, 144 patients with CKD who underwent gastric ESD between May 2003 and October 2012 were enrolled. The patients were divided into three groups: stage 3 (estimated glomerular filtration rate [eGFR]: 30 – 59 mL/min), stage 4 (eGFR: 15 – 29 mL/min), and stage 5 (eGFR: < 15 mL/min) according to the Kidney Disease Improving Global Outcomes Guidelines. The en bloc and curative resection rates and complications were assessed as short-term outcomes. Overall survival was analyzed using Kaplan – Meier methods. Results: In total, 92 patients were in stage 3 CKD; 23 in stage 4; and 29 in stage 5, including 19 patients in hemodialysis. The en bloc resection rate was 95.8 %. Post-ESD bleeding was observed in four patients with stage 5 CKD (13.8 %), three with stage 4 (13.0 %), and one with stage 3 (1.1 %). All bleeding could be controlled by endoscopic hemostasis, but five patients required blood transfusion. Perforation occurred in two patients (6.9 %) with stage 5 CKD, none (0 %) with stage 4, and two (4.3 %) with stage 3. Multivariate Poisson regression analysis revealed CKD stage 4 was a critical factor related to bleeding, whereas diabetes mellitus and CKD stage 5, which largely consist of patients receiving hemodialysis, were not. The median observation period of patients who achieved curative resection was 25.9 months (range 0.8—112.7 months) and the 3-year overall survival rate was 92.5 %. Conclusions: Estimated GFR is a significant independent predictive factor of post-ESD bleeding in patients with CKD.

Initial Management of Colonic Diverticular Bleeding: Observational Study

“…A history of CKD has been reported to be associated with increased risk for re-bleeding in previous studies [15, 17], and it was also a risk factor in our study. The possible mechanisms of bleeding in patients with CKD may be platelet abnormalities and platelet-vessel wall interaction [30, 31]. We also found that a history of CDB would be a risk factor.…”

Postoperative bleeding risk after gastric endoscopic submucosal dissection during antithrombotic drug therapy

“…Bonferroni correction was performed when comparing more than two groups. Variables with P values of < 0.05 on the univariate analysis and some valuables that were reported to be significant factors for postoperative bleeding in Table 2 The clinical characteristics of the lesions in the post-ESD bleeding group and the no post-ESD bleeding group previous studies 5,[19][20][21] were included in multivariate logistic regression models. A logistic regression analysis was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and identify the factors associated with postoperative bleeding.…”

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

“…A meta‐analysis indicated that the significant risk factors for delayed bleeding after gastric ESD were antithrombotic drug intake, CKD, resected specimen size >30 mm, and use of a H2RA instead of a PPI . Among these risk factors, CKD had the highest risk (odds ratio of 3.38) of delayed bleeding ranging from 13.5% to 33.3% (Table ) …”

“…66 Among these risk factors, CKD had the highest risk (odds ratio of 3.38) of delayed bleeding ranging from 13.5% to 33.3% (Table 3). [67][68][69] Use of antithrombotic agents is also one of the risk factors for delayed bleeding after gastric ESD. Japanese Gastroenterological Endoscopy Society (JGES) guidelines, however, recommend carrying out high-bleeding-risk procedure without interruption of low-dose aspirin (LDA) therapy in patients who are at high risk for thromboembolic events.…”