Risk factors for delayed bleeding from endoscopic submucosal dissection of gastric neoplasms.
OBJECTIVE
Delayed bleeding is a major complication of endoscopic submucosal dissection (ESD) of gastric neoplasms. We aimed to clarify risk factors for delayed bleeding from ESD.


METHODS
This study included 447 patients in whom 544 gastric neoplasms were resected by ESD between April 2006 and March 2011 in Yamaguchi University Hospital. We analyzed risk factors for delayed bleeding from ESD in relation to various clinical and pathological factors.


RESULTS
En bloc resection rate was 95.4% (519/544), and curative resection rate was 87.8% (477/544). Delayed bleeding occurred in 7.0% (38/544) and perforation occurred in 1.8% (10/544) of patients. Univariate analysis revealed platelet count (Plt) <15 × 10⁴/μl (p = 0.013), prothrombin time (PT) <70% (p = 0.044), resected size ≥ 50 mm (p = 0.038), and positive/indeterminate lateral margin (p = 0.012) to be risk factors for delayed bleeding. Multivariate analysis showed that Plt <15 × 10⁴/μl (odds ratio [OR], 2.62; 95% confidence interval [CI]: 1.17-5.53, p = 0.020) and positive/indeterminate lateral margin (OR, 5.45; 95% CI: 1.39-17.95, p = 0.018) were independent risk factors for delayed bleeding.


CONCLUSIONS
Low Plt, low PT, large resected size, and positive/indeterminate lateral margin were significant risk factors for delayed bleeding from ESD. Patients with these risk factors must be carefully observed for signs of delayed bleeding.
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Munetaka
M
Nakamura
Jun
J
Nishikawa
Kouichi
K
Hamabe
Junichi
J
Nishimura
Masaaki
M
Satake
Atsushi
A
Goto
Shu
S
Kiyotoki
Mari
M
Saito
Yuki
Y
Fukagawa
Yasuyuki
Y
Shirai
Takeshi
T
Okamoto
Isao
I
Sakaida
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D004210:Dissection / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D013272:Stomach Diseases / Q000209:etiology; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*