Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection--an analysis of risk factors

Endoscopy. 2008 Mar;40(3):179-83. doi: 10.1055/s-2007-995530.


Background and study aim: Endoscopic submucosal dissection (ESD) has been reported to be associated with a higher complication rate than standard endoscopic mucosal resection. We aimed to clarify the risk factors for delayed bleeding after ESD for early gastric cancer (EGC).

Methods: 1083 EGCs in 968 consecutive patients undergoing ESD during a 4-year period were reviewed. Post-ESD coagulation (PEC) preventive therapy of visible vessels in the resection area, using a coagulation forceps, was introduced and mostly performed during the later 2 years. Various factors related to patients, tumors, and treatment including PEC were investigated using univariate and multivariate analysis with regard to delayed post-ESD bleeding, evidenced by hematemesis or melena, that required endoscopic treatment.

Results: Delayed bleeding occurred after ESD of 63 lesions (5.8 % of all lesions and 6.5 % of patients), controlled in all cases by endoscopic hemostasis; blood transfusion was required in only one case. Tumor location in the upper third of the stomach and PEC were independent factors indicating a lower rate of delayed bleeding according to both univariate and multivariate analysis.

Conclusions: This retrospective study suggested that preventive coagulation of visible vessels in the resection area after ESD may lead to a lower bleeding rate.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Dissection / adverse effects*
  • Endoscopy / adverse effects*
  • Female
  • Gastric Mucosa / surgery*
  • Hemostasis, Surgical
  • Humans
  • Male
  • Middle Aged
  • Postoperative Hemorrhage / etiology*
  • Postoperative Hemorrhage / prevention & control*
  • Retrospective Studies
  • Risk Factors
  • Stomach Neoplasms / surgery*
  • Time Factors