title: Usefulness of endoscopic ultrasound for the prediction of intraoperative bleeding of endoscopic submucosal dissection for gastric neoplasms.
abstract: OBJECTIVE
  Intraoperative bleeding is an important determining factor for the technical difficulty and safety of endoscopic submucosal dissection (ESD) for gastric neoplasms, which was previously difficult to predict before ESD. In the present study, we investigated whether endoscopic ultrasound (EUS) could be used to preoperatively predict intraoperative bleeding.
  
  
  METHODS
  The study included 106 patients who underwent EUS before ESD. EUS was used to evaluate the submucosal vascular structure. Patients who had at least 10 vascular structures per field of view or a vessel at least 500 µm in diameter were classified into the rich group (Group R), and others were classified into the non-rich group (Group N). The two groups were compared retrospectively with respect to procedure time, degree of anemia, frequency of clip use, and others.
  
  
  RESULTS
  There were 24 patients in Group R and 82 patients in Group N. Submucosal caner was found in 54.2% of patients in Group R and 18.3% in Group N. The reduction in hemoglobin was 5.8% in Group R and 3.45% in Group N. The procedure time was 151 min in Group R and 100 min in Group N. The frequency of clip use was 79.2% in Group R and 31.7% in Group N. A multivariate analysis revealed a significant difference in the depth of invasion and frequency of clip use between the two groups.
  
  
  CONCLUSIONS
  The results suggest that identification of submucosal vascular structure by EUS might allow prediction of intraoperative bleeding during ESD.
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan. dkiku@toranomon.gr.jp
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kikuchi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iizuka
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kuroki
authors.forename: Toshihumi
authors.initials: T
authors.lastname: Mitani
authors.forename: Ai
authors.initials: A
authors.lastname: Fujimoto
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Noriko
authors.initials: N
authors.lastname: Nishida
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology; D016063:Blood Loss, Surgical / Q000517:prevention & control; D016009:Chi-Square Distribution; D019160:Endosonography; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects*; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013525:Surgical Instruments; D013997:Time Factors