title: Management of systolic blood pressure after endoscopic submucosal dissection is crucial for prevention of post-ESD gastric bleeding.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is a useful technique for early gastric neoplasms without lymph node metastasis. However, a critical complication is unpredictable post-ESD bleeding. Some risk factors for post-ESD bleeding have been reported previously, although those risk factors have not directly contributed toward prevention of post-ESD bleeding.
  
  
  METHODS
  We retrospectively identified 186 gastric neoplasms in 183 consecutive patients treated with ESD from 2005 to 2012 at Nagoya City University Hospital, and divided them into two groups on the basis of the presence or absence of post-ESD bleeding.
  
  
  RESULTS
  Of the 186 lesions, eight lesions (4.2%) developed post-ESD bleeding. Univariate analysis identified hypertension (38.8% in nonbleeding vs. 87.5% in bleeding; P=0.009) and depressed-type tumors (26.4% in nonbleeding vs. 62.5% in bleeding; P=0.040) as significantly related to the incidence of post-ESD bleeding. On multivariate analysis, hypertension (odds ratio, 11.55; 95% confidence interval, 1.20-111.66; P=0.034) and depressed-type tumors (odds ratio, 5.36; 95% confidence interval, 1.12-25.73; P=0.036) were independent risk factors for post-ESD bleeding. Systolic blood pressure (SBP) after ESD was significantly higher in the post-ESD bleeding group than in the post-ESD non-bleeding group (P=0.021), with the comorbidity of hypertension significantly correlating with SBP after ESD (ρ=0.332, P<0.001).
  
  
  CONCLUSIONS
  Control of SBP after ESD is important for the prevention of post-ESD bleeding because hypertension as a comorbidity, which is associated positively with SBP after ESD, is a significant risk factor for post-ESD bleeding.
authors.affiliation: aDepartment of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan bVascular Biology Program, Boston Children's Hospital cDepartment of Surgery, Harvard Medical School and Boston Children's Hospital, Boston, USA.
authors.forename: Masahide
authors.initials: M
authors.lastname: Ebi
authors.forename: Takaya
authors.initials: T
authors.lastname: Shimura
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Nishiwaki
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
authors.forename: Hironobu
authors.initials: H
authors.lastname: Tsukamoto
authors.forename: Keiji
authors.initials: K
authors.lastname: Ozeki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sawada
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Mizoshita
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Mori
authors.forename: Eiji
authors.initials: E
authors.lastname: Kubota
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanida
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kataoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Joh
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D015897:Comorbidity; D004210:Dissection / Q000009:adverse effects*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D005773:Gastroscopy / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents