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International Journal of Colorectal Disease

, Volume 29, Issue 7, pp 877–882 | Cite as

Risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal neoplasms

  • Motomi Terasaki
  • Shinji TanakaEmail author
  • Kenjiro Shigita
  • Naoki Asayama
  • Soki Nishiyama
  • Nana Hayashi
  • Koichi Nakadoi
  • Shiro Oka
  • Kazuaki Chayama
Original Article

Abstract

Purpose

Although delayed bleeding is a major complication of endoscopic submucosal dissection (ESD) for colorectal neoplasms, few reports have assessed the risk factors for delayed bleeding after colorectal ESD.

Methods

This study included 363 consecutive patients in whom 377 colorectal neoplasms were resected using ESD between April 2006 and August 2012. We classified patients and lesions into two groups on the basis of presence or absence of delayed bleeding and retrospectively compared the clinicopathological characteristics and clinical outcomes of ESD between the two groups.

Results

Delayed bleeding occurred in 25 (6.6 %) of 377 lesions, and all cases of delayed bleeding were successfully controlled by endoscopic procedures. With respect to patient-related factors, there was no significant difference between the groups in mean age, sex ratio, and current use of antithrombotic agents. With respect to lesion-related factors, there was no significant difference between the groups in mean lesion size, growth pattern, and mean procedure time (p = 0.6). Lesions located in the rectum (vs colon, p = 0.0005) and lesions with severe submucosal fibrosis (vs no or mild fibrosis, p = 0.022) were significantly related to delayed bleeding. Upon multivariate analysis, lesions located in the rectum (vs colon, odds ratio 4.19; p = 0.0009) were significantly related to delayed bleeding after colorectal ESD.

Conclusions

This study demonstrated that location of lesions in the rectum was a significant independent risk factor for delayed bleeding after ESD for colorectal neoplasms.

Keywords

Colorectal neoplasm Endoscopic submucosal dissection Delayed bleeding Submucosal fibrosis 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Recipi A, Hassan C, Carlino A, Pagano N, Zullo A, Rando G, Strangio G, Romeo F, Nicita R, Malesci A (2010) Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 71:715–721CrossRefGoogle Scholar
  2. 2.
    Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamaguchi N, Omata M (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 70:860–866PubMedCrossRefGoogle Scholar
  3. 3.
    Gotoda T, Yamamoto H, Soetikno RM (2006) Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 41:929–942PubMedCrossRefGoogle Scholar
  4. 4.
    Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future prospective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651PubMedCrossRefGoogle Scholar
  5. 5.
    Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107PubMedCrossRefGoogle Scholar
  6. 6.
    Yahagi N, Fujishiro M, Omata M (2004) Endoscopic submucosal dissection of colorectal lesion. Dig Endosc 16(Suppl S2):S178–S181CrossRefGoogle Scholar
  7. 7.
    Tamegai Y, Saito Y, Masaki N, Hionhara C, Oshima T, Kogure E, Liu Y, Yemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39:418–422PubMedCrossRefGoogle Scholar
  8. 8.
    Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu K, Saito D (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66:966–973PubMedCrossRefGoogle Scholar
  9. 9.
    Saito Y, Uraoka T, Yamaguchi Y et al (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225PubMedCrossRefGoogle Scholar
  10. 10.
    Tanaka S, Terasaki M, Kanao H, Oka S, Chayama K (2012) Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc 24(Suppl 1):73–79PubMedCrossRefGoogle Scholar
  11. 11.
    Tanaka S, Terasaki M, Hayashi N, Oka S, Chayama K (2013) Warning for unprincipled colorectal endoscopic submucosal dissection: accurate diagnosis and reasonable treatment strategy. Dig Endosc 25:107–116PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Matsumoto A, Tanaka S, Oba S, Kanao H, Oka S, Yoshihara M, Chayama K (2010) Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 45:1329–1337PubMedCrossRefGoogle Scholar
  13. 13.
    Lee EJ, Lee JB, Choi YS, Lee SH, Lee DH, Kim do S, Youk EG (2012) Clinical risk factors for perforation during endoscopic submucosal dissection (ESD) for large sized, nonpedunculated colorectal tumors. Surg Endosc 26:1587–1594PubMedCrossRefGoogle Scholar
  14. 14.
    Kim ES, Cho KB, Park KS, Lee K, Jang BK, Chung WJ, Hwang JS (2011) Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy 43:573–578PubMedCrossRefGoogle Scholar
  15. 15.
    Tanaka S, Oka S, Chayama K (2008) Strategy of endoscopic treatment for colorectal tumor: recent progress and perspective. In: Niwa H, Tajiri H, Nakajima M, Yasuda K (eds) New challenges in gastrointestinal endoscopy. Springer, Tokyo, pp 353–366CrossRefGoogle Scholar
  16. 16.
    Oba S, Tanaka S, Oka S, Kanao H, Yoshida S, Shimamoto F, Chayama K (2010) Characterization of colorectal tumors using narrow-band imaging magnification: combined diagnosis with both pit pattern and microvessel features. Scand J Gastroenterol 45:1084–1092PubMedCrossRefGoogle Scholar
  17. 17.
    Kanao H, Tanaka S, Oka S, Kaneko I, Yoshida S, Arihiro K, Yoshihara M, Chayama K (2008) Clinical significance of type V(I) pit pattern subclassification in determining the depth of invasion of colorectal neoplasm. World J Gastroenterol 14:211–217PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Tanaka S, Oka S, Hirata M, Yoshida S, Kaneko I, Chayama K (2006) Pit pattern diagnosis for colorectal neoplasia using narrow band imaging magnification. Dig Endosc 18(Suppl 1):S52–S56CrossRefGoogle Scholar
  19. 19.
    Hirata M, Tanaka S, Oka S, Kaneko I, Yoshida S, Yoshihara M, Chayama K (2007) Magnifying endoscopy with narrow band imaging for diagnosis of colorectal tumors. Gastrointest Endosc 65:988–995PubMedCrossRefGoogle Scholar
  20. 20.
    Ozawa SI, Tanaka S, Hayashi N, Nishiyama S, Nakadoi K, Kanao H, Oka S, Yoshida S, Chayama K (2013) Risk factors for vertical incomplete resection in endoscopic submucosal dissection as total excisional biopsy for submucosal invasive colorectal carcinoma. Int J Colorectal Dis 28:1247–1256PubMedCrossRefGoogle Scholar
  21. 21.
    Boman FT, Carneiro F, Hruban RH, Theise ND (eds) (2010) WHO classification of tumours of the digestive system, 4th edn. IARC, Lyon, France, pp 134–146Google Scholar
  22. 22.
    Watanabe T, Itabashi M, Shimada Y et al (2012) Japanese Society for Cancer of Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29PubMedCrossRefGoogle Scholar
  23. 23.
    Tajiri H, Kitano S (2004) Complications associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental. Dig Endosc 16(Suppl Sl):S134–S136CrossRefGoogle Scholar
  24. 24.
    Kudo S, Lambert R, Allen JI et al (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68(Suppl 4):S3–S47PubMedCrossRefGoogle Scholar
  25. 25.
    Higashiyama M, Oka S, Tanaka S, Tanaka S, Sanomura Y, Imagawa H, Shishido T, Yoshida S, Chayama K (2011) Risk factors for bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm. Dig Endosc 23:290–295PubMedCrossRefGoogle Scholar
  26. 26.
    Koh R, Hirakawa K, Yahara S et al (2013) Antithrombic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms. Gastrointest Endosc 78:476–483PubMedCrossRefGoogle Scholar
  27. 27.
    Toyokawa T, Inaba T, Omote S et al (2012) Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions. J Gastroenterol Hepatol 27:907–912PubMedCrossRefGoogle Scholar
  28. 28.
    Matsumoto M, Fukunaga S, Saito Y, Matsuda T, Nakajima T, Sakamoto T, Tamai N, Kikuchi T (2012) Risk factors for delayed bleeding after endoscopic resection for large colorectal tumors. Jpn J Clin Oncol 42:1028–1034PubMedCrossRefGoogle Scholar
  29. 29.
    Shioji K, Suzuki Y, Kobayashi M, Nakamura A, Azumaya M, Takeuchi M, Baba Y, Honma T, Narisawa R (2003) Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 57:691–694PubMedCrossRefGoogle Scholar
  30. 30.
    Hui AJ, Wong RM, Ching JY, Hung LC, Chung SC, Syng JJ (2004) Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc 59:44–48PubMedCrossRefGoogle Scholar
  31. 31.
    Rosen L, Bub D, Reed JF 3rd, Nastasee SA (1993) Hemorrhage following colonoscopic polypectomy. Dis Colon Rectum 36:1126–1131PubMedCrossRefGoogle Scholar
  32. 32.
    Uraoka T, Higashi R, Kato J et al (2011) Colorectal endoscopic submucosal dissection for elderly patients at least 80 years of age. Surg Endosc 25:3000–3007PubMedCrossRefGoogle Scholar
  33. 33.
    Hurlstone DP, Atkinson R, Sanders DS, Thomson M, Cross SS, Brown S (2007) Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg 94:1536–1542PubMedCrossRefGoogle Scholar
  34. 34.
    Probst A, Golger D, Anthuber M, Märkl B, Messmann H (2012) Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center. Endoscopy 44:660–667PubMedCrossRefGoogle Scholar
  35. 35.
    Tanaka S, Tamegai Y, Tsuda S et al (2010) Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc 22(Suppl 1):S2–S8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Motomi Terasaki
    • 1
  • Shinji Tanaka
    • 2
    Email author
  • Kenjiro Shigita
    • 1
  • Naoki Asayama
    • 1
  • Soki Nishiyama
    • 1
  • Nana Hayashi
    • 1
  • Koichi Nakadoi
    • 1
  • Shiro Oka
    • 2
  • Kazuaki Chayama
    • 1
  1. 1.Department of Gastroenterology and MetabolismHiroshima University Graduate School of Biomedical SciencesHiroshimaJapan
  2. 2.Department of EndoscopyHiroshima University HospitalHiroshimaJapan

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