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Risk factors of delayed ulcer healing after gastric endoscopic submucosal dissection

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Abstract

Background

Although post-endoscopic submucosal dissection (ESD) iatrogenic ulcer is known to heal faster than peptic ulcer, some iatrogenic ulcers show delayed healing. The aim of this study was to clarify risk factors of delayed ulcer healing after gastric ESD.

Methods

We retrospectively reviewed medical records of all patients who had ESD for gastric neoplasms (866 adenomas and 814 early gastric cancers) between January 2005 and February 2011.

Results

Of 1680 subjects, 95 had delayed ulcer healing in 3-month follow-up. Multivariate analysis showed that diabetes (OR 1.743; 95 % CI 1.017–2.989, p = 0.043), coagulation abnormality (OR 3.195; 95 % CI 1.535–6.650, p = 0.002), specimen size greater than 4 cm (OR 2.999; 95 % CI 1.603–5.611, p = 0.001), and electrocoagulation (OR 7.149; 95 % CI 1.738–29.411, p = 0.006) were revealed to be independent risk factors of delayed ulcer healing. Meanwhile, persistent Helicobacter pylori infection was not related to the delayed ulcer healing.

Conclusions

Large iatrogenic ulcer by ESD with massive hemostasis, especially in patients with diabetes mellitus or coagulation abnormalities, tends to take more than 3 months to heal. For such cases, initial dosage increment of PPI or addition of other anti-ulcer agents after ESD may be beneficial.

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Acknowledgments

This work was supported by a grant from Liver Research Institute, Seoul National University College of Medicine.

Disclosure

Authors Joo Hyun Lim, Sang Gyun Kim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim, and Hyun Chae Jung have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Intestinal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea

    Joo Hyun Lim

  2. Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Yongun-dong 28, Chongno-gu, Seoul, 110-744, South Korea

    Sang Gyun Kim, Jeongmin Choi, Jong Pil Im, Joo Sung Kim & Hyun Chae Jung

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  1. Joo Hyun Lim
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  2. Sang Gyun Kim
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  3. Jeongmin Choi
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Correspondence to Sang Gyun Kim.

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Lim, J.H., Kim, S.G., Choi, J. et al. Risk factors of delayed ulcer healing after gastric endoscopic submucosal dissection. Surg Endosc 29, 3666–3673 (2015). https://doi.org/10.1007/s00464-015-4123-z

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  • DOI: https://doi.org/10.1007/s00464-015-4123-z

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