title: Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm.
abstract: BACKGROUND
  Various endoscopic submucosal dissection (ESD)-related complications, such as perforation or bleeding, occur frequently. However, the clinical course of coagulation syndrome (CS) after ESD is not known. The aim of this study was to clarify the clinical outcomes and predictive factors of CS after ESD for early gastric lesions.
  
  
  METHODS
  ESD procedures were performed in the typical sequence (marking, incision, and submucosal dissection). Four hundred and ninety-five patients with early gastric neoplasms were classified into two groups based on their clinical course after ESD: one group with post-ESD CS and the other with a normal clinical course. The clinical outcomes of the CS group were analyzed, and various clinical and pathological factors related to post-ESD CS were investigated using univariate and multivariate analyses.
  
  
  RESULTS
  Coagulation syndrome occurred after ESD in 35 patients. In the CS group, the median period of inflammatory symptoms was 23.7 ± 12.0 h, and no blood cultures showed bacteremia. Multivariate analysis demonstrated that a tumor size of more than 1.5 cm [odds ratio (OR) 5.99, P < 0.001], tumor location in the middle third of the stomach (OR 2.84, P = 0.005), and a procedural time longer than 45 min (OR 2.71, P = 0.033) were independent risk factors for this complication. All patients with CS presented with a favorable outcome, irrespective of antibiotic treatment.
  
  
  CONCLUSIONS
  This study suggests that CS occurs with an incidence of 7.1% after ESD for gastric lesions, and the factors associated with post-ESD CS include tumor size and location, and procedural duration.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 134 Shinchon-dong, Sodaemun-gu, Seoul, Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.forename: Kyung Seok
authors.initials: KS
authors.lastname: Cheoi
authors.forename: Hyunsoo
authors.initials: H
authors.lastname: Chung
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents