title: Risk factors for immediate and delayed bleeding associated with endoscopic submucosal dissection of gastric neoplastic lesions.
abstract: OBJECTIVE. Endoscopic submucosal dissection (ESD) of gastric neoplasia has been reported to have a higher bleeding rate than conventional endoscopic mucosal resection (EMR). The aim of this study was to identify the risk factors for bleeding associated with ESD. MATERIAL AND METHODS. The records of consecutive patients who underwent ESD for gastric adenoma/early gastric cancer were reviewed. Potential risk factors included patient age, lesion size, gross findings, location, and histology of the tumor. The primary end-point was the incidence of immediate or delayed bleeding related to ESD. RESULTS. A total of 144 patients were studied; bleeding occurred in 32 cases (22.2%) with immediate bleeding in 29 cases. Delayed bleeding (3 cases) occurred at day 2 (2 patients) and at day 7 in 1 patient. In all cases of immediate bleeding, immediate hemostatic therapy was successful. The histology of tumor was the only factor that was statistically significantly associated with bleeding (adjusted hazard ratio 6.770, 95% confidence interval 1.830-25.048, p=0.004). CONCLUSIONS. The only factor that correlated with an increased risk of bleeding with ESD was the presence of gastric malignancy. We found no factor that would, prospectively, be amenable to prevention of bleeding.
authors.affiliation: Department of Internal Medicine, Dong-A Medical Center, University College of Medicine, Busan, Korea.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Jang
authors.forename: Seok Reyol
authors.initials: SR
authors.lastname: Choi
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.forename: Hyuk-Chan
authors.initials: HC
authors.lastname: Kwon
authors.forename: Min Chan
authors.initials: MC
authors.lastname: Kim
authors.forename: Jin Sook
authors.initials: JS
authors.lastname: Jeong
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Won
authors.forename: Sang Young
authors.initials: SY
authors.lastname: Han
authors.forename: Myung Hwan
authors.initials: MH
authors.lastname: Noh
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Seung Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Yang Hyun
authors.initials: YH
authors.lastname: Baek
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Kim
authors.forename: Dong Seong
authors.initials: DS
authors.lastname: Jeong
authors.forename: Seul Ki
authors.initials: SK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors