title: Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor.
abstract: OBJECTIVE
  Although endoscopic mucosal resection has been recognized as the standard treatment for gastric mucosal neoplasm, postendoscopic mucosal resection hemorrhage remains a major complication of endoscopic mucosal resection, and this problem seems to be increasing owing to the development of invasive techniques. The aims of this study were to determine the incidence and grade of postendoscopic mucosal resection hemorrhage and to identify risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric neoplasm.
  
  
  METHODS
  Data of endoscopic mucosal resections performed by three endoscopists were retrospectively collected over 8 years and then analyzed. Immediate postendoscopic mucosal resection hemorrhage was defined as bleeding during the procedure. Delayed postendoscopic mucosal resection hemorrhage was defined when two of the four following parameters were satisfied after the endoscopic mucosal resection period; (i) hematemesis, melena or dizziness, (ii) hemoglobin loss >2 g/dl, (iii) blood pressure decrease >20 mmHg or pulse rate increase >20/min and (iv) Forrest I or IIa-IIb on follow-up endoscopy.
  
  
  RESULTS
  A total of 157 patients (mean age: 64 years, male : female=44 : 113) were reviewed. Twenty-nine (18.5%) and 13 patients (8.3%) presented with immediate and delayed postendoscopic mucosal resection hemorrhage, respectively. Multivariate logistic regression analysis revealed that the patient's age (<or=65 years; odds ratio 6.11, 95% confidence interval 1.12-33.43), the size of lesion (>15 mm; odds ratio 5.90, 95% confidence interval 1.13-30.87) and the experience of the endoscopist (<or=5 years; odds ratio 16.31, 95% confidence interval 1.46-181.97) were significantly predictive variables for the delayed postendoscopic mucosal resection hemorrhage.
  
  
  CONCLUSIONS
  Considering the higher risk of delayed postendoscopic mucosal resection hemorrhage, careful preparation and close monitoring are required for patients who are less than 65 years, have large lesions over 15 mm or if the procedures were performed by an inexperienced endoscopist.
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Park
authors.forename: Yong Soon
authors.initials: YS
authors.lastname: Park
authors.forename: Myeong Gwan
authors.initials: MG
authors.lastname: Jee
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Lee
mesh_terms: D000367:Age Factors; D000368:Aged; D002983:Clinical Competence; D004812:Epidemiologic Methods; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011184:Postoperative Period; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*