Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions

被引:1
作者
Yosuke Tsuji [1 ]
Ken Ohata [1 ]
Takafumi Ito [1 ]
Hideyuki Chiba [1 ]
Tomohiko Ohya [2 ]
Toshiaki Gunji [3 ]
Nobuyuki Matsuhashi [1 ]
机构
[1] Department of Gastroenterology,Kanto Medical Center,NTT EC
[2] Department of Endoscopy,The Jikei University School of Medicine
[3] Center for Preventive Medicine,Kanto Medical Center,NTT EC
关键词
Bleeding; Endoscopic submucosal dissection; Ulcer floor; Anti-thrombotic drugs; Coagulation;
D O I
暂无
中图分类号
R735.2 [胃肿瘤];
学科分类号
100214 ;
摘要
AIM:To assess risk factors for bleeding after gastric endoscopic submucosal dissection(ESD) and to develop preventive measures.METHODS:This retrospective study was performed in a tertiary referral center.A total of 328 patients underwent ESD for 398 gastric neoplasms between July 2007 and June 2009.The main outcome was association between post-ESD bleeding and the following:age;sex;comorbidities;daily use of medicine potentially related to gastric injury/bleeding;location,size,and histological depth of lesions;ulceration;experience of operator coagulating the ulcer floor,and duration of operation.We also determined the relationship between the location of post-ESD bleeding and risk factors for hemorrhage.RESULTS:Univariate analysis revealed significant risk factors:tumor location [odds ratio(OR),2.86;95% CI:1.21-6.79,P=0.024],coagulator experience(OR,4.29;95% CI:1.43-12.86,P=0.009),and medicine potentially related to gastric injury/bleeding(OR,2.80;95% CI:1.14-6.90,P=0.039).Multivariate logistic regression analysis confirmed significant,independent risk factors:tumor in lower third of stomach(OR,2.47;95% CI:1.02-5.96,P=0.044),beginner coagulator(OR,3.93;95% CI:1.29-11.9,P=0.016),and medicine(OR,2.76;95% CI:1.09-6.98,P=0.032).We classif ied cases of post-ESD bleeding into two groups(bleeding at the ulcer margin vs bleeding at the center) and found that bleeding at the margin occurred more frequently with beginner coagulators compared with experts(OR,16.00;95% CI:1.22-210.59,P=0.040).CONCLUSION:Beginner coagulators,tumor in the antrum,and medicines were significant risk factors for post-ESD bleeding.Bleeding at the ulcer margin frequently occurred with beginner operators.
引用
收藏
页码:2913 / 2917
页数:5
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