title: Risk factors for bleeding evaluated using the Forrest classification in Japanese patients after endoscopic submucosal dissection for early gastric neoplasm.
abstract: OBJECTIVE
  Bleeding remains a serious complication after endoscopic submucosal dissection (ESD). Second-look endoscopy for hemostasis helps prevent post-ESD bleeding. We investigated the relationships between patient characteristics, tumor characteristics, and the Forrest classification for exposed vessels on artificial ulcers after ESD and evaluated whether hemostasis during second-look endoscopy was useful for preventing post-ESD bleeding.
  
  
  METHODS
  We analyzed 250 patients (265 lesions) who underwent ESD for gastric neoplasms. Vessels classified by Forrest classifications during scheduled second-look endoscopy were analyzed for associations with patient characteristics, tumor characteristics, and recurrent bleeding.
  
  
  RESULTS
  Two of 250 patients (0.8%) underwent emergency hemostatic endoscopy before scheduled second-look endoscopy. The remaining 248 patients (99.2%) underwent scheduled second-look endoscopy on the day after ESD. Patients with Forrest classification Ia, Ib, or IIa vessels had a significantly higher risk for recurrent bleeding after scheduled second-look endoscopy compared with patients with IIb or III vessels according to univariate analysis (P<0.05) and multivariate logistic regression analysis (odds ratio: 3.45; 95% confidence interval: 1.04-11.41; P=0.042). Univariate analysis indicated that hemodialysis correlated significantly with the presence of Ia, Ib, or IIa vessels compared with that of IIb or III vessels found during second-look endoscopy (P<0.05). Multivariate analysis indicated a significant relationship between hemodialysis and recurrent bleeding after second-look endoscopy (odds ratio: 10.05; 95% confidence interval: 1.97-51.26; P=0.006).
  
  
  CONCLUSIONS
  Hemodialysis is a risk factor for post-ESD bleeding. Proper classification of exposed vessels within post-ESD ulcers according to the Forrest classification using second-look endoscopy might help predict or prevent recurrent bleeding.
authors.affiliation: Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan.
authors.forename: Hisatsugu
authors.initials: H
authors.lastname: Noda
authors.forename: Naotaka
authors.initials: N
authors.lastname: Ogasawara
authors.forename: Shinya
authors.initials: S
authors.lastname: Izawa
authors.forename: Tomonori
authors.initials: T
authors.lastname: Ozeki
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Yanamoto
authors.forename: Noriko
authors.initials: N
authors.lastname: Okaniwa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanabe
authors.forename: Makoto
authors.initials: M
authors.lastname: Sasaki
authors.forename: Kunio
authors.initials: K
authors.lastname: Kasugai
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D016009:Chi-Square Distribution; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D005773:Gastroscopy / Q000009:adverse effects* / Q000379:methods; D006489:Hemostatic Techniques; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D024162:Second-Look Surgery; D013274:Stomach Neoplasms / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome