title: Delayed bleeding after endoscopic submucosal dissection for non-ampullary superficial duodenal neoplasias might be prevented by prophylactic endoscopic closure: analysis of risk factors.
abstract: OBJECTIVE
  Duodenal endoscopic submucosal dissection (ESD) is technically challenging because of anatomical specificities and, to date, has not been validated concerning the high rate of complications such as perforation and delayed bleeding. In the present study, the risk factors for delayed bleeding after duodenal ESD are presented with the goal of establishing preventive measures.
  
  
  METHODS
  We analyzed 63 patients with non-ampullary superficial duodenal neoplasias treated by ESD from April 2005 to March 2014. To analyze the risk factors of delayed bleeding after duodenal ESD, we divided the patients into a delayed bleeding group and a non-bleeding group. To verify the risk factors of delayed bleeding after duodenal ESD, we analyzed various patient-, lesion-, and treatment-related factors.
  
  
  RESULTS
  Delayed bleeding was experienced in 11 patients (17.5%) Univariate analysis of patient-related risk factors of delayed bleeding indicated no significant risk factor. Univariate analysis of lesion-related and treatment-related risk factors indicated only endoscopic closure as a significant risk factor. Multivariate analysis also identified endoscopic closure (not done > done: P = 0.049) as an independent factor significantly associated with delayed bleeding after duodenal ESD. Hypertension (present > absent: P = 0.055) showed a non-significant tendency of association by multivariate analysis.
  
  
  CONCLUSIONS
  This retrospective evaluation found that endoscopic closure was associated with a reduced risk of delayed bleeding after duodenal ESD. Delayed bleeding after duodenal ESD might be prevented by prophylactic endoscopic closure.
authors.affiliation: Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Hoteya
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.forename: Toshiro
authors.initials: T
authors.lastname: Iizuka
authors.forename: Osamu
authors.initials: O
authors.lastname: Ogawa
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Mitani
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kikuchi
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Furuhata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamada
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Kimura
authors.forename: Kousuke
authors.initials: K
authors.lastname: Nomura
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kuribayashi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Miyata
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004210:Dissection / Q000379:methods; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D004384:Duodenoscopy / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000503:physiopathology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: complication; delayed bleeding; endoscopic closure; endoscopic submucosal dissection (ESD); superficial duodenal neoplasia