Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Jun 21, 2010; 16(23): 2913-2917
Published online Jun 21, 2010. doi: 10.3748/wjg.v16.i23.2913
Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions
Yosuke Tsuji, Ken Ohata, Takafumi Ito, Hideyuki Chiba, Tomohiko Ohya, Toshiaki Gunji, Nobuyuki Matsuhashi
Yosuke Tsuji, Ken Ohata, Takafumi Ito, Hideyuki Chiba, Nobuyuki Matsuhashi, Department of Gastroenterology, Kanto Medical Center, NTT EC, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
Tomohiko Ohya, Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan
Toshiaki Gunji, Center for Preventive Medicine, Kanto Medical Center, NTT EC, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan
Author contributions: Tsuji Y and Ohata K performed the endoscopic procedures, designed the study and wrote the manuscript; Ito T, Chiba H and Ohya T performed the endoscopic procedures and provided technical support; Matsuhashi N revised the article and gave the final approval of it; Gunji T provided advice on the statistical analysis of the data.
Supported by Kanto Medical Center, NTT EC
Correspondence to: Dr. Yosuke Tsuji, Department of Gastroenterology, Kanto Medical Center, NTT EC, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan. ytsuji-tky@umin.ac.jp
Telephone: +81-3-34486111 Fax: +81-3-34486544
Received: February 1, 2010
Revised: April 8, 2010
Accepted: April 15, 2010
Published online: June 21, 2010
Abstract

AIM: To assess risk factors for bleeding after gastric endoscopic submucosal dissection (ESD) and to develop preventive measures.

METHODS: This retrospective study was performed in a tertiary referral center. A total of 328 patients underwent ESD for 398 gastric neoplasms between July 2007 and June 2009. The main outcome was association between post-ESD bleeding and the following: age; sex; comorbidities; daily use of medicine potentially related to gastric injury/bleeding; location, size, and histological depth of lesions; ulceration; experience of operator coagulating the ulcer floor, and duration of operation. We also determined the relationship between the location of post-ESD bleeding and risk factors for hemorrhage.

RESULTS: Univariate analysis revealed significant risk factors: tumor location [odds ratio (OR), 2.86; 95% CI: 1.21-6.79, P = 0.024], coagulator experience (OR, 4.29; 95% CI: 1.43-12.86, P = 0.009), and medicine potentially related to gastric injury/bleeding (OR, 2.80; 95% CI: 1.14-6.90, P = 0.039). Multivariate logistic regression analysis confirmed significant, independent risk factors: tumor in lower third of stomach (OR, 2.47; 95% CI: 1.02-5.96, P = 0.044), beginner coagulator (OR, 3.93; 95% CI: 1.29-11.9, P = 0.016), and medicine (OR, 2.76; 95% CI: 1.09-6.98, P = 0.032). We classified cases of post-ESD bleeding into two groups (bleeding at the ulcer margin vs bleeding at the center) and found that bleeding at the margin occurred more frequently with beginner coagulators compared with experts (OR, 16.00; 95% CI: 1.22-210.59, P = 0.040).

CONCLUSION: Beginner coagulators, tumor in the antrum, and medicines were significant risk factors for post-ESD bleeding. Bleeding at the ulcer margin frequently occurred with beginner operators.

Keywords: Bleeding; Endoscopic submucosal dissection; Ulcer floor; Anti-thrombotic drugs; Coagulation