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

Park, So-Eun; Kim, Do Hoon; Jung, Hwoon‐Yong; Lim, Hyun; Ahn, Ji Yong; Choi, Kyeong‐Hee; Lee, Jeong Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Kim, Jin-Ho; Han, Seungbong

doi:10.1007/s00464-015-4250-6

Cited by 14 publications

(12 citation statements)

References 24 publications

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“…Aspirin was used by 591 (24.7%) CCA cases and 2,129 (44.6%) controls. Aspirin use was significantly associated with a 2.7- to 3.6-fold decreased risk for all CCA subtypes [65]. Preclinical studies have already revealed that COX-2 is implicated in cholangiocarcinogenesis in vitro and in tumour growth in rats [66,67].…”

Section: Aspirinmentioning

confidence: 99%

Epidemiology and Risk Factors of Cholangiocarcinoma

Kirstein

Vogel²

2016

Visc Med

151

127

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Background: Cholangiocarcinoma (CCA) is the second most common primary liver cancer, being characterized by its late diagnosis and fatal outcome. Recent epidemiological reports indicate an increasing worldwide incidence of intrahepatic CCA but a decreasing incidence of extrahepatic CCA. Methods: In this review, we present an overview of the incidence and epidemiology of CCA and possible strategies for screening and surveillance. Results: Efficient strategies for the screening and surveillance of CCA have not been established so far. The vast majority of CCA occur sporadically without any apparent cause; however, several risk factors such as liver flukes, chronic biliary and liver diseases, and lifestyle-related aspects causing chronic inflammation and cholestasis in the liver have been linked to the development of CCA. These risk factors likely contribute to the increased incidence observed in some countries and also explain the wide geographical differences in the incidence of CCA. Conclusion: Several risk factors for CCA have been identified. Given the dismal prognosis of advanced CCA, regular surveillance examinations with a combination of ultrasonography and laboratory tests appear to be useful in patients at risk and need to be explored in prospective trials.

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Section: Aspirinmentioning

confidence: 99%

Epidemiology and Risk Factors of Cholangiocarcinoma

Kirstein

Vogel²

2016

Visc Med

151

127

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“…The reported incidence of ESD-related bleeding varies. The reported intra-procedural and PEB rates were 11.9–45.1% and 5.1%, respectively 3,14,15 . Bleeding is inevitable during mucosal incision and submucosal dissection using an electrosurgical knife.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed bleeding by onset time after endoscopic submucosal dissection for gastric neoplasm

Nam

Choi

Kim

et al. 2019

Sci Rep

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Post-endoscopic submucosal dissection bleeding (PEB) is one of the important complications after endoscopic submucosal dissection (ESD), but still difficult to predict. The present study aimed to identify significant risk factors for PEB according to onset time. Between November 2008 and January 2016, a total of 1864 lesions resected via ESD were analyzed. PEB was classified as either early or late according to onset time (within or after 24 hours post-ESD, respectively). During second-look endoscopy, the artificial ulcer bed was subjected to Forrest classification. A high risk of stigma was defined as active spurting bleeding, oozing bleeding, and a non-bleeding visible vessel in the ulcer. The endoscopic factors and medications associated with PEB were analyzed. PEB occurred in 77 lesions (4.1%): early only in 46 (2.4%), late only in 22 (1.1%), and early and late in 9 (0.4%). Among 55 early PEB events, 25 were asymptomatic and diagnosed during second-look endoscopy. Age ≤65 years, resection size ≥30 mm, procedure time ≥20 min, lower third of the stomach, erosion, and clopidogrel use were significantly associated with early PEB. If the number of risk factors were ≤1, the risk of early PEB was 0.6%. For late PEB, the mid to upper third of the stomach, undifferentiated carcinoma, erosion, high risk of stigma during second-look endoscopy, history of early PEB, and clopidogrel use were significant risk factors. If risk factors were absent, the risk of late PEB was 0.1%. For patients at high risk of early PEB, selective second-look endoscopy might be a useful. For patients at high risk of late PEB, careful monitoring of bleeding should be considered.

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“…In comparison, patients taking anticoagulation drugs have an increased risk of delayed bleeding of 6.7 % after esophageal endoscopic resection [32]. For gastric resection, about 10 % of resections are complicated by delayed bleeding, and this rate is similar in non-cirrhosis [33] and cirrhosis [34] cases. Duodenal resections are known to be prone to bleeding in non-cirrhosis populations, with an estimated rate of about 16 % [27,35,36].…”

Section: Discussionmentioning

confidence: 99%

Safe and effective digestive endoscopic resection in patients with cirrhosis: a single-center experience

et al. 2020

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Background Endoscopic resection has developed over the years. The main complications are perforation and bleeding. This study aimed to evaluate safety and effectiveness of digestive endoscopic resection in patients with cirrhosis. Methods This retrospective, open-label, single-center study included all consecutive patients with cirrhosis who were admitted for endoscopic resection between 2009 and 2016. Safety, efficacy, and risk factors for delayed bleeding were analyzed. Results 126 patients undergoing 164 procedures were included: 65 endoscopic resections (49 patients) in the upper gastrointestinal tract (esophagus 34, stomach 20, duodenum 11) and 99 in the lower gastrointestinal tract (77 patients). Mean Model for End-Stage Liver Disease score was 9.9 (standard deviation 4.5). Esophageal varices were present in 50 patients, and 21 patients had decompensated cirrhosis. The overall curative rate of endoscopic resection was 84.0 %. No patients died during 30-day follow-up. Immediate overall morbidity was 6.1 %, with two postoperative fevers and eight bleeds. Risk factors for delayed bleeding were duodenal location (P < 0.01), antiplatelet medication (P = 0.02), and lower glomerular filtration rate (GFR) (P = 0.01) in univariate analysis. Duodenal location and lower GFR remained statistically significant in multivariate analysis, with respective odds ratios for bleeding of 52.12 and 1.04. No liver decompensation occurred after endoscopic resection. Conclusions Endoscopic resection was safe and effective in patients with mild (Child – Pugh class A/B) cirrhosis, and should be proposed as a first option for treatment of superficial neoplasia. Additional data in patients with severe cirrhosis are needed to confirm the safety in this population.

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

Cited by 14 publications

References 24 publications

Epidemiology and Risk Factors of Cholangiocarcinoma

Epidemiology and Risk Factors of Cholangiocarcinoma

Risk factors for delayed bleeding by onset time after endoscopic submucosal dissection for gastric neoplasm

Safe and effective digestive endoscopic resection in patients with cirrhosis: a single-center experience

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