title: Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms.
abstract: OBJECTIVE
  To investigate the risk factors for delayed bleeding following endoscopic submucosal dissection (ESD) treatment for colorectal neoplasms.
  
  
  METHODS
  We retrospectively reviewed the medical records of 317 consecutive patients with 325 lesions who underwent ESD for superficial colorectal neoplasms at our hospital from January 2009 to June 2013. Delayed post-ESD bleeding was defined as bleeding that resulted in overt hematochezia 6 h to 30 d after ESD and the observation of bleeding spots as confirmed by repeat colonoscopy or a required blood transfusion. We analyzed the relationship between risk factors for delayed bleeding following ESD and the following factors using univariate and multivariate analyses: age, gender, presence of comorbidities, use of antithrombotic drugs, use of intravenous heparin, resected specimen size, lesion size, lesion location, lesion morphology, lesion histology, the device used, procedure time, and the presence of significant bleeding during ESD.
  
  
  RESULTS
  Delayed post-ESD bleeding was found in 14 lesions from 14 patients (4.3% of all specimens, 4.4% patients). Patients with episodes of delayed post-ESD bleeding had a mean hemoglobin decrease of 2.35 g/dL. All episodes were treated successfully using endoscopic hemostatic clips. Emergency surgery was not required in any of the cases. Blood transfusion was needed in 1 patient (0.3%). Univariate analysis revealed that lesions located in the cecum (P = 0.012) and the presence of significant bleeding during ESD (P = 0.024) were significantly associated with delayed post-ESD bleeding. The risk of delayed bleeding was higher for larger lesion sizes, but this trend was not statistically significant. Multivariate analysis revealed that lesions located in the cecum (OR = 7.26, 95%CI: 1.99-26.55, P = 0.003) and the presence of significant bleeding during ESD (OR = 16.41, 95%CI: 2.60-103.68, P = 0.003) were independent risk factors for delayed post-ESD bleeding.
  
  
  CONCLUSIONS
  Location in the cecum and significant bleeding during ESD predispose patients to delayed post-procedural bleeding. Therefore, careful and additional management is recommended for these patients.
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Chino
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Teruhito
authors.initials: T
authors.lastname: Kishihara
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uragami
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Tamegai
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Suganuma
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Fujisaki
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Matsuura
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Igarashi
authors.affiliation: Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D004210:Dissection; D004724:Endoscopy; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
keywords: Adverse event; Bleeding; Colorectal neoplasms; Endoscopic submucosal dissection; Hemorrhage