Different clinical characteristics associated with acute bleeding and delayed bleeding after endoscopic submucosal dissection in patients with early gastric cancer
Few studies have classified risk factors according to the onset time of bleeding after endoscopic submucosal dissection (post-ESD bleeding).
We studied 1767 consecutive lesions in patients who underwent ESD for early gastric cancer from December 2006 through June 2016. Patients who had a remnant stomach or who had undergone reconstruction with a gastric tube were excluded. Post-ESD bleeding was classified into acute bleeding (0–5 days after ESD) and delayed bleeding (6 or more days after ESD), and the risk factors for each type of bleeding were compared.
Post-ESD bleeding occurred in 150 (8.5%) of 1767 lesions. Bleeding was acute in 129 lesions (7.3%) and delayed in 21 (1.2%). Acute post-ESD bleeding was frequently associated with lesions located in the distal stomach, expanded indications or non-indicated lesions, a specimen diameter of ≥40 mm, and antithrombotic therapy. Delayed post-ESD bleeding was often associated with lesions located in the proximal stomach, hemodialysis, and antithrombotic therapy. Among 334 lesions in patients who received antithrombotic therapy, post-ESD bleeding occurred in 47 lesions (14.1%). Independent risk factors for post-ESD bleeding were a specimen diameter of ≥40 mm and treatment with 2 or more antithrombotic agents.
Acute post-ESD bleeding and delayed post-ESD bleeding were associated with different clinical characteristics. Antithrombotic therapy is a risk factor for post-ESD bleeding in both the acute and delayed phases.
KeywordsEarly gastric cancer Endoscopic submucosal dissection Bleeding Delayed Acute
Compliance with ethical standards
Conflict of interest
Takafumi Yano, Satoshi Tanabe, Kenji Ishido, Mizuto Suzuki, Natsuko Kawanishi, Sakiko Yamane, Akinori Watanabe, Takuya Wada, Mizutomo Azuma, Chikatoshi Katada and Wasaburo Koizumi declares that they have no conflict of interest.
- 2.Uedo N, Takeuchi Y, Yamada T, Ishihara R, Ogiyama H, Yamamoto S, Kato M, Tatsumi K, Masuda E, Tamai C, Yamamoto S, Higashino K, Iishi H, Tatsuta M (2007) Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial. Am J Gastroenterol 102:1610–1616CrossRefPubMedGoogle Scholar
- 3.Yang Z, Wu Q, Liu Z, Wu K, Fan D (2011) Proton pump inhibitors versus histamine-2-receptor antagonists for the management of iatrogenic gastric ulcer after endoscopic mucosal resection or endoscopic submucosal dissection: a meta-analysis of randomized trials. Digestion 84:315–320CrossRefPubMedGoogle Scholar
- 4.Koh R, Hirasawa K, Yahara S, Oka H, Sugimori K, Morimoto M, Numata K, Kokawa A, Sasaki T, Nozawa A, Taguri M, Morita S, Maeda S, Tanaka K (2013) Antithrombotic drugs are risk factors for delayed postoperative bleeding after endoscopic submucosal dissection for gastric neoplasms. Gastrointest Endosc 78:476–482CrossRefPubMedGoogle Scholar
- 8.Mochizuki S, Uedo N, Oda I, Kaneko K, Yamamoto Y, Yamashina T, Suzuki H, Kodashima S, Yano T, Yamamichi N, Goto O, Shimamoto T, Fujishiro M, Koike K, SAFE Trial Study Group (2015) Scheduled second-look endoscopy is not recommended after endoscopic submucosal dissection for gastric neoplasms (the SAFE trial):a multicenter prospective randomized controlled non-inferiority trial. Gut 64:397–405CrossRefPubMedGoogle Scholar
- 12.Kazuei O (2005) The management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastroenterol Endosc 47:2691–2695(In Japanese)Google Scholar
- 16.Toyokawa T, Inaba T, Omote S, Okamoto A, Miyasaka R, Watanabe K, Izumikawa K, Horii J, Fujita I, Ishikawa S, Morikawa T, Murakami T, Tomoda J (2012) Risk factors for perforation and delayed bleeding associated with endoscopic submucosal dissection for early gastric neoplasms: analysis of 1123 lesions. J Gastroenterol Hepatol 27:907–912CrossRefPubMedGoogle Scholar
- 22.Matsumura T, Arai M, Maruoka D, Okimoto K, Minemura S, Ishigami H, Saito K, Nakagawa T, Katsuno T, Yokosuka O (2014) Risk factors for early and delayed post-operative bleeding after endoscopic submucosal dissection of gastric neoplasms, including patients with continued use of antithrombotic agents. BMC Gastroenterol 14:172CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Kagawa T, Iwamuro M, Ishikawa S, Ishida M, Kuraoka S, Sasaki K, Sakakihara I, Izumikawa K, Yamamoto K, Takahashi S, Tanaka, Matsuura M, Hasui T, Wato M, Inaba T (2016) Vonoprazan prevents bleeding from endoscopic submucosal dissection-induced gastric ulcers. Aliment Pharmacol Ther 44:583–591CrossRefPubMedGoogle Scholar
- 33.Tsuji Y, Fujishiro M, Kodashima S, Ono S, Niimi K, Mochizuki S, Asada-Hirayama I, Matsuda R, Minsatsuki C, Nakayama C, Takahashi Y, Sakaguchi Y, Yamamichi N, Koike K (2015) Polyglycolic acid sheets and fibrin glue decrease the risk of bleeding after endoscopic submucosal dissection of gastric neoplasms (with video). Gastrointest Endosc 81:906–912CrossRefPubMedGoogle Scholar