Risk factors for bleeding evaluated using the Forrest classification in Japanese patients after endoscopic submucosal dissection for early gastric neoplasm

Abstract

Hemodialysis is a risk factor for post-ESD bleeding. Proper classification of exposed vessels within post-ESD ulcers according to the Forrest classification using second-look endoscopy might help predict or prevent recurrent bleeding.

Efficacy of hemostatic powder in preventing bleeding after gastric endoscopic submucosal dissection in high‐risk patients

“…Table shows the endoscopic findings on second‐look endoscopy according to the Forrest classification after ESD in our study and recent studies . These studies were carried out on patients with an average risk of post‐ESD bleeding and were not aimed at high‐risk patients.…”

“…These studies were carried out on patients with an average risk of post‐ESD bleeding and were not aimed at high‐risk patients. Five prospective studies showed that the proportion of Forrest classification Ia, Ib, and IIa lesions ranged from 15.1% to 64.2%. The proportion of actively bleeding lesions (Forrest Ia and Ib) in previous studies ranged from 9.6% to 14.0% .…”

“…Five prospective studies showed that the proportion of Forrest classification Ia, Ib, and IIa lesions ranged from 15.1% to 64.2%. The proportion of actively bleeding lesions (Forrest Ia and Ib) in previous studies ranged from 9.6% to 14.0% . A retrospective study at our institute aimed at patients with an average risk of post‐ESD bleeding reported that the proportion of Forrest I and IIa lesions was 21.1%.…”

“…In the present prospective study, the use of polysaccharide hemostatic powder (Endo‐Clot™) to prevent post‐ESD bleeding in high‐risk patients was demonstrated. In previous studies, there was controversy about some risk factors for post‐ESD bleeding, such as advanced age, previous gastric surgery, tumor location, histology, invasion depth, and routine second look endoscopy . However, in many previous studies and meta‐analyses, antithrombotic agents and large resection size were clear strong risk factors for post‐ESD bleeding .…”

“…As there has been no previous study about the efficacy of hemostatic powder, we assumed that the rate of post‐ESD ulcers at high risk for delayed bleeding would be 5%. According to previous studies, we assumed that the rate of post‐ESD ulcers at high risk for delayed bleeding without hemostatic powder application would be 20% . With a two‐sided type I error of 0.05 and type II error of 0.2, 42 patients were required for the study group.…”