Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm

Abstract

Risk factors for delayed bleeding, and the probable underlying mechanism involved, differed depending on the time elapsed between surgery and the bleeding episode.

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

“…34 Furthermore, 10 studies found no significant differences in elderly patients, 19,25,30,[35][36][37][38][39][40][41] although 1 study identified age > 80 years as an independent risk factor for PPB. 42 PPB rates were similar between genders in most studies, [13][14][15][16][17][18][20][21][22][23][25][26][27][28][29][30][31][32][33][34]36,39,[42][43][44] with only 1 study reporting an association male sex associated with PPB. 24 Arterial hypertension was not identified as a risk factor in most studies, [13][14][15]17,18,[20][21][22][23][24][28]…”

“…42 PPB rates were similar between genders in most studies, [13][14][15][16][17][18][20][21][22][23][25][26][27][28][29][30][31][32][33][34]36,39,[42][43][44] with only 1 study reporting an association male sex associated with PPB. 24 Arterial hypertension was not identified as a risk factor in most studies, [13][14][15]17,18,[20][21][22][23][24][28][29][30][31]33,42,43,45 although 2 studies reported significantly higher PPB rates in hypertensive patients. 16,36 However, the adjusted OR was .67 in the latter study.…”

“…25 Other clinical factors were analyzed in a few studies. Helicobacter pylori infection, 13,14,22 body mass index, 22,29,36 hyperlipidemia, 24,29,31,34,42 hyperuricemia, 36 pulmonary disease, 34 history of peptic ulcer, 31 hemoglobin level, 22 prothrombin, and activated partial thromboplastin time 22,25 were not found to be associated with PPB. Thrombocytopenia was associated with PPB in 1 study, 43 although 2 studies did not find differences in PPB rates.…”

“…36 Similarly, diabetes mellitus was not identified as a significant risk factor in any study. [13][14][15][16][17][18][20][21][22][23][24][28][29][30][31]33,34,36,42,44,45 Cardiopathy (ischemic heart disease in most studies), 10 were not identified as risk factors for PPB in most studies. Chronic kidney disease was not identified as a risk factor in some studies despite a trend to higher bleeding.…”

Endoscopic submucosal dissection: Sociedad Española de Endoscopia Digestiva (SEED) clinical guideline

“…In gastric lesions an increased risk of bleeding has been reported when the lesions are located either in the middle or upper third of the stomach. Elderly (> 80 years), procedure time, size (≥ 40 mm) and endoscopist experience have been also associated with an increased risk of bleeding (95)(96)(97)(98).…”