title: Clinical risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal tumors in Japanese patients.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) is a curative, standard therapy for colorectal neoplasms. Some studies have investigated the risk factors for perforation during colorectal ESD. However, few studies have assessed the risk factors for delayed bleeding after colorectal ESD. We studied patients undergoing ESD for colorectal epithelial neoplasms to identify the risk factors for post-ESD bleeding.
  
  
  METHODS
  We studied 124 consecutive patients undergoing ESD for colorectal epithelial neoplasms. To identify risk factors for delayed bleeding post-ESD, recurrent bleeding post-ESD was compared with patient-related and tumor-related factors.
  
  
  RESULTS
  Delayed bleeding after ESD occurred in 10 (8.1%) lesions of 124 colorectal tumors, and the median time from the end of ESD to the onset of bleeding was 18.5 h. Delayed bleeding was significantly higher in tumors located in rectums than in colons (P=0.021), and the number of occurrences of arterial bleeding during ESD was significantly higher in the delayed bleeding group than in the nondelayed bleeding group (P=0.002). The procedure time was significantly longer in the delayed bleeding group than in the nondelayed bleeding group (P=0.012). On multivariate logistic regression analysis, tumor location (odds ratio, 10.13; 95% confidence interval, 1.18-87.03; P=0.035) and three or more occurrences of arterial bleeding during ESD (odds ratio, 6.86; 95% confidence interval, 1.13-41.5; P=0.036) were significant independent risk factors for delayed bleeding.
  
  
  CONCLUSIONS
  The presence of lesions in the rectum and three or more arterial bleeding occurrences during ESD were risk factors for post-ESD bleeding. Patients with these risk factors should be followed up carefully after ESD for colorectal epithelial neoplasms.
authors: Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan.
authors: Naotaka
authors: N
authors: Ogasawara
authors: Takashi
authors: T
authors: Yoshimine
authors: Hisatsugu
authors: H
authors: Noda
authors: Yoshihiro
authors: Y
authors: Kondo
authors: Shinya
authors: S
authors: Izawa
authors: Tetsuya
authors: T
authors: Shinmura
authors: Masahide
authors: M
authors: Ebi
authors: Yasushi
authors: Y
authors: Funaki
authors: Makoto
authors: M
authors: Sasaki
authors: Kunio
authors: K
authors: Kasugai
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D065311:Adenocarcinoma in Situ / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003106:Colon / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D047368:Tumor Burden