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Risk factors and correlations of immediate, early delayed, and late delayed bleeding associated with endoscopic resection for gastric neoplasms

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Abstract

Background

Bleeding is a major complication following endoscopic resection (ER) of gastric mucosal lesions. We aimed to determine the risk factors for post-ER bleeding and their correlations according to the time elapsed since the procedure.

Methods

We retrospectively enrolled 670 lesions in 610 patients who underwent ER between March 2009 and December 2010. We classified these lesions into three types in accordance with the bleeding time, i.e., immediate bleeding (IB), early delayed bleeding (EDB), and late delayed bleeding (LDB). We analyzed the risk factors for each bleeding type according to baseline patient characteristics, procedure-related factors, and correlations between the occurrence of each bleeding type.

Results

There were 408 post-ER bleeding events in our study cohort: 302 IB events, 88 EDB events, and 18 LDB events. In multivariate analysis, a histologic finding of carcinoma and the resection time were significant predictors of IB (p < 0.001). Of the 302 IB events, 13.9 % showed EDB. Additionally, LDB occurred in 2.4 % of lesions with EDB and 4.6 % of lesions without EDB. Similar to the IB group, of 368 lesions without IB, 12.5 % showed EDB. In addition, LDB occurred in 2.2 % of lesions with EDB and 1.2 % of lesions without EDB. IB was associated with a higher risk of EDB (p < 0.001) and LDB (p < 0.001), whereas EDB was not related to an increased risk of LDB (p = 0.997).

Conclusion

IB significantly increases the risk of EDB and LDB, but EDB does not increase the risk of LDB. Histologically confirmed carcinoma or a prolonged time for resection increases the risk of post-ER IB. We recommend careful follow-up approaches following ER of a gastric mucosal lesion in high-risk patients to prevent a potentially critical occurrence of delayed bleeding.

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Disclosures

Dr. So-Eun Park, Do Hoon Kim, Hwoon-Yong Jung, Hyun Lim, Ji Yong Ahn, Kwi-Sook Choi, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim and Seungbong Han have no conflicts of interest or financial ties to disclose.

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Author notes

    Authors and Affiliations

    1. Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

      So-Eun Park, Do Hoon Kim, Hwoon-Yong Jung, Ji Yong Ahn, Kwi-Sook Choi, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee & Jin-Ho Kim

    2. Department of Applied Statistics, Gachon Univertisy, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 461-701, Korea

      Seungbong Han

    3. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

      Hyun Lim

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    1. So-Eun Park
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    Correspondence to So-Eun Park.

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    So-Eun Park and Do Hoon Kim have contributed equally to this article.

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    Park, SE., Kim, D.H., Jung, HY. et al. Risk factors and correlations of immediate, early delayed, and late delayed bleeding associated with endoscopic resection for gastric neoplasms. Surg Endosc 30, 625–632 (2016). https://doi.org/10.1007/s00464-015-4250-6

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    • DOI: https://doi.org/10.1007/s00464-015-4250-6

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