title: Analysis of delayed bleeding after endoscopic submucosal dissection for gastric epithelial neoplasms.
abstract: Aim. Delayed bleeding after endoscopic submucosal dissection (ESD) for gastric epithelial neoplasms is a major complication. We investigated factors related to post-ESD bleeding to identify preventive measures. Methods. The study included 161 gastric epithelial neoplasms in 142 patients from June 2007 to September 2010. Post-ESD bleeding was defined as an ulcer with active bleeding or apparent exposed vessels diagnosed by an emergency endoscopy or a planned follow-up endoscopy. We analyzed associations between bleeding and the following factors: age, sex, morphology, pathology, tumor depth, ulcer presence/absence, location, size of the resected lesion, duration of the procedure, the number of times bleeding occurred during ESD, and the use of anticoagulants and/or antiplatelet drugs. Subsequently, we examined characteristics of bleeding cases. Results. Post-ESD bleeding occurred in 21 lesions. Univariate analysis of these cases showed that ulcer presence/absence (P < 0.001), middle or lower third lesions (P = 0.036), circumference (P = 0.014), and a post-ESD ulcer with an extended lesser curve (P = 0.009) were significant predictors of bleeding. Multivariate analysis showed that ulcer presence/absence (OR 9.73, 95% CI 2.28-41.53) was the only significant predictor. Conclusion. Ulcer presence/absence was considered the most significant predictor of post-ESD bleeding.
authors.affiliation: Department of Internal Medicine, Miyoshi Central Hospital, 531 Higashisakeya-chou, Miyoshi, Hiroshima 728-8502, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Mukai
authors.forename: Songde
authors.initials: S
authors.lastname: Cho
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kotachi
authors.forename: Akinori
authors.initials: A
authors.lastname: Shimizu
authors.forename: Genta
authors.initials: G
authors.lastname: Matuura
authors.forename: Michihiro
authors.initials: M
authors.lastname: Nonaka
authors.forename: Toshihide
authors.initials: T
authors.lastname: Hamada
authors.forename: Ken
authors.initials: K
authors.lastname: Hirata
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakanishi