Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms

Suzuki, Shinichi; Chino, Akiko; Kishihara, Teruhito; Uragami, Naoyuki; Tamegai, Yoshiro; Suganuma, Takanori; Fujisaki, Junko; Matsuura, M.; Itoi, Takao; Gotoda, Takuji; Igarashi, Masahiro; Moriyasu, Fuminori

doi:10.3748/wjg.v20.i7.1839

Cited by 66 publications

(53 citation statements)

References 26 publications

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“…Some studies reported that bleeding was associated with lesion size and tumor location; for example, the hazard of post-ESD bleeding was higher when the lesions were located in the cecum, but it was difficult to stratify patients by these factors in our meta-analysis (31,32). There were also some unanswered questions regarding the bleeding of post-ESD and aspirin use.…”

Section: Discussionmentioning

confidence: 77%

Continued use of low-dose aspirin may increase risk of bleeding after gastrointestinal endoscopic submucosal dissection: A meta-analysis

Chen²,

Ding³

et al. 2017

Turk J Gastroenterol

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Section: Discussionmentioning

confidence: 77%

Continued use of low-dose aspirin may increase risk of bleeding after gastrointestinal endoscopic submucosal dissection: A meta-analysis

Chen²,

Ding³

et al. 2017

Turk J Gastroenterol

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“…Despite variations in the bleeding rates, the post-ESD bleeding rate has been reported to be equal to or higher than the post-EMR bleeding rate (27)(28)(29)(30)(31)(32)(33)(34). Postoperative bleeding has been reported to occur in approximately 5.3-16.5% of patients after gastric ESD (28)(29)(30)(31) and in 4.4% after colorectal ESD (34).…”

Section: Methodsmentioning

confidence: 99%

“…The rate of postoperative bleeding is particularly increasing, as more patients are undergoing therapeutic endoscopy [e.g., endoscopic submucosal dissection (ESD), and endoscopic mucosal resection (EMR)] for early malignant lesions in the gastrointestinal tract (27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Methodsmentioning

confidence: 99%

“…Postoperative bleeding has been reported to occur in approximately 5.3-16.5% of patients after gastric ESD (28)(29)(30)(31) and in 4.4% after colorectal ESD (34). In most patients, postoperative bleeding can be successfully treated by endoscopic hemostasis, although one UGIB study reported no significant differences in the rates of re-bleeding and uncontrolled bleeding requiring surgical hemostasis between patients with peptic ulcer and postoperative ulcer (35).…”

Section: Methodsmentioning

confidence: 99%

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Clinical Backgrounds and Outcomes of Elderly Japanese Patients with Gastrointestinal Bleeding

et al. 2016

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Objective Elderly gastrointestinal bleeding (GIB) patients sometimes cannot be discharged home. In some cases, they die after hemostasis, even following appropriate treatment. This study investigates the clinical backgrounds and outcomes of elderly Japanese GIB patients. Methods The medical records of 185 patients (123 men, 62 women; mean age 68.2 years; range 10-99 years) with GIB symptoms who underwent esophagogastroduodenoscopy or colonoscopy to detect or treat the source of GIB were retrospectively reviewed. We compared the outcomes between patients ! 70 (n=85) and >70 (n=100) years. The clinical backgrounds of the patients who died or changed hospitals to undergo rehabilitation or receive palliative care were evaluated, as were the association of four factors with these poor outcomes: GIB (re-bleeding or uncontrolled bleeding), endoscopic procedure-related complications, exacerbation of the pre-existing comorbidity, and any complications that were not directly related to GIB. Results Of the patients ! 70 and >70 years of age, three (3.5%) and 17 (17.0%), respectively, were transferred to another hospital (p=0.003). One (1.2%) and five (5.0%), respectively, died (p=0.144). All three patients ! 70 years old that changed hospitals did so because their comorbidities became worse. The reasons for changing hospitals in the 17 patients >70 years of age included exacerbation of a pre-existing comorbidity (41.1%, 7/17), other complications (35.4%, 6/17), GIB itself (17.6%, 3/17), and endoscopic procedure-related complications (5.9%, 1/17). Conclusion Although non-elderly and elderly GIB patients had similar mortality rates, many more elderly patients could not be discharged home for various reasons.

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“…In the rectum, below the peritoneal reflection, perforation can be of little consequence, but if it occurs higher in the colon the patient must be observed with antibiotic treatment for several days to ensure delayed peritonitis does not ensue. Delayed bleeding (<2.2%) seems to be fairly infrequent after ESD, possibly because major vessels are coagulated during the proce dure 118 clipping, use of haemostatic forceps, or haemostatic sprays, prevents the need for arterial embolization or emergency surgery 119,120 .…”

Section: Esd Complicationsmentioning

confidence: 99%

Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps

Saunders

Tsiamoulos

2016

Nat Rev Gastroenterol Hepatol

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Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR.

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Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms

Abstract: Location in the cecum and significant bleeding during ESD predispose patients to delayed post-procedural bleeding. Therefore, careful and additional management is recommended for these patients.

Cited by 66 publications

References 26 publications

Continued use of low-dose aspirin may increase risk of bleeding after gastrointestinal endoscopic submucosal dissection: A meta-analysis

Continued use of low-dose aspirin may increase risk of bleeding after gastrointestinal endoscopic submucosal dissection: A meta-analysis

Clinical Backgrounds and Outcomes of Elderly Japanese Patients with Gastrointestinal Bleeding

Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps

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