Analysis of risk factors for delayed bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm
10.3760/cma.j.cn112152-20210118-00057
- VernacularTitle:内镜黏膜下剥离术治疗早期胃癌及癌前病变发生迟发性出血的相关因素分析
- Author:
Yu GONG
1
;
Yueming ZHANG
;
Jiqing ZHU
;
Shun HE
;
Lizhou DOU
;
Yong LIU
;
Yan KE
;
Xudong LIU
;
Yumeng LIU
;
Hairui WU
;
Ying LYU
;
Guiqi WANG
Author Information
1. 国家癌症中心 国家肿瘤临床医学研究中心 中国医学科学院北京协和医学院肿瘤医院内镜科 100021
- Keywords:
Gastric neoplasm;
Precancerous lesion;
Endoscopic submucosal dissection;
Delayed bleeding;
Risk factor
- From:
Chinese Journal of Oncology
2021;43(8):861-865
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To determine the potential risk factors of delayed hemorrhage after endoscopic submucosal dissection (ESD) in patients with early gastric carcinomas or precancerous lesions.Methods:The clinical data of 637 patients with early gastric carcinomas (EGC) who treated with ESD in Department of Endoscopy at Cancer Hospital, Chinese Academy of Medical Sciences, from August 2013 to August 2019, were retrospectively analyzed. Univariate analysis and multivariate logistic analysis were conducted to evaluate the risk factors associated with delayed bleeding.Results:A total of 699 lesions in 637 patients, of which 696 lesions were resected enbloc, the curative resection rate was 92.1% (644/699). The pathological diagnosis after ESD showed that 46 cases were low-grade intraepithelial neoplasia, 71 were high-grade intraepithelial neoplasia, and 582 were cancer. Delayed bleeding occurred in 74 lesions, while other 625 lesions without postoperative bleeding. The incidence was 10.6%. Compared with the non-bleeding group, there were statistically significant differences in the maximum length of the lesion, the gross shape of the lesion, the control of intra operative bleeding, and the operation time in the delayed bleeding group ( P<0.05). Multivariate logistic regression analysis showed that the maximum length of the lesion and the gross shape of the lesion were independent factors of delayed bleeding after ESD. Delayed bleeding was inclined to occur in patients with lesion size ≥3.0 cm ( OR=1.958, 95% CI: 1.162-3.299) and the superficial and flat lesion ( OR=10.598, 95% CI: 1.313-85.532) after ESD. Conclusions:The maximum length of the lesion and the gross shape of the lesion are independent impact factors of delayed bleeding occurring in patients with EGC and precancerous lesions after ESD. Patients with lesion size≥3 cm, or superficial flat lesion should be paid attention after ESD operation. It needs to take timely measures to prevent the very likely bleeding in order to ensure postoperative recovery and improve the quality of life for postoperative patients.
