Risk factors for delayed hemorrhage in patients with early gastric carcinoma after endoscopic submucosal dissection and its predictive value
- VernacularTitle:内镜黏膜下剥离术后早期胃癌患者迟发性出血的危险因素及其预测价值研究
- Author:
Jinling GUO
1
;
Xiuning ZHANG
;
Lu LIU
;
Xulei ZHANG
;
Dan LI
;
Heqian GAO
Author Information
- Publication Type:Journal Article
- Keywords: early gastric carcinoma(EGC); endoscopic submucosal dissection(ESD); delayed hemorrhage; risk factors; predictive value
- From: China Journal of Endoscopy 2025;31(9):62-68
- CountryChina
- Language:Chinese
- Abstract: Objective To analyze the risk factors for delayed hemorrhage in patients with early gastric carcinoma(EGC)after endoscopic submucosal dissection(ESD),as well as to explore the predictive value of predictive models.Methods The clinical data of 386 EGC treated with ESD patients from July 2019 to March 2024 were retrospectively analyzed.They were followed up for a short period of time(24 h～30 d postoperatively)after ESD,and were divided into the group of occurrence(50 cases)and the group of non-occurrence(336 cases)according to the occurrence or non-occurrence of delayed hemorrhage.To understand the clinical data of the patients,multivariate Logistic regression was used to analyze the risk factors for delayed hemorrhage in patients with EGC after ESD,and plot receiver operating characteristic curve(ROC curve)to analyze the predicted value.Results The proportions of cardia gastric fundus,lesion diameter ≥ 3 cm,submucosa with fibrosis,coarse blood vessels,and having ulcer or scar in the occurrence group were significantly higher than those in the non-occurrence group,the differences were statistically significant(P＜0.05).The results of multivariate Logistic regression analysis(with an introduction level of 0.05)showed that the lesion location was cardia-gastric fundus(OR=1.088,95％CI:1.040～1.138),the diameter of the lesion was ≥3 cm(OR=1.095,95％CI:1.057～1.135),and fibrosis under the mucosa(OR=1.130,95％CI:1.061～1.203),thick blood vessels under the mucosa(OR=1.177,95％CI:1.116～1.241),and the presence of ulcer or scar(OR=1.082,95％CI:1.057～1.108)were the risk factors for the occurrence of delayed hemorrhage in patients with EGC after ESD(P＜0.05).A prediction model was established:Logit(P)=-9.238+Location of lesion as cardia-gastric fundus × 0.084+Diameter of lesion ≥ 3 cm× 0.091+Submucosal with fibrosis × 0.122+Submucosal with thick blood vessels × 0.163+Ulcer or scar×0.079(P＜0.05),the likelihood ratio test yielded x2=131.09,DF=8,P＜0.05,which indicated that the constructed prediction model was valid.Hosmer-Lemeshow goodness-of-fit test showed a good model fit(P＞0.05).The ROC curve showed an area under the curve(AUC)value of 0.929 at a cutoff value of 12.00,with a sensitivity of 88.00％(95％CI:0.757～0.955)and a specificity of 83.04％(95％CI:0.780～0.869).Conclusion Postoperative delayed hemorrhage in patients with EGC treated with ESD is associated with cardia-gastric fundus,lesion diameter ≥3 cm,submucosal fibrosis,thick blood vessels,and the presence of ulcer or scar,and the prediction value of the prediction model constructed accordingly is good.
