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

Abstract EN

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.