Risk factors for bleeding after gastric ESD (endoscopic submucosal dissection)

Authors and Affiliations:
Diogo Libânio (IPO-Porto), Mariana Costa (Centro Hospitalar Lisboa Central), Pedro Pimentel-Nunes (IPO-Porto), Mário Dinis-Ribeiro (IPO-Porto)

Abstract:

BACKGROUND AND AIMS: Post-procedural bleeding (PPB) is the most common adverse event associated with endoscopic resection. Several studies tried to identify risk factors for PPB after gastric endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) with controversial results. This systematic review and meta-analysis aimed at identifying significant risk factors for PPB after gastric EMR and ESD. METHODS: Three online databases were searched. Pooled OR was computed for each risk factor using random-effects model and heterogeneity was assessed by Cochran's Q test and I2. RESULTS: Seventy-four articles were included. Pooled PPB rate was 5.1% (95% CI 4.5-5.7%), not varying according to different study designs. Male sex (OR 1.25), cardiopathy (OR 1.54), antithrombotic drugs (OR 1.63), cirrhosis (OR 1.76), chronic kidney disease (OR 3.38), tumor size >20 mm (OR 2.70), resected specimen size >30mm (OR 2.85), localization in the lesser curvature (OR 1.74), flat/depressed morphology (OR 1.43), carcinoma histology (OR 1.46), and ulceration (OR 1.64) were identified as significant risk factors for PPB, whereas age, hypertension, submucosal invasion, fibrosis, and localization (upper, middle, or lower third) were not. Procedure duration >60 minutes (OR 2.05) and the use of histamine-2 receptor antagonists instead of proton pump inhibitors (OR 2.13) were the procedural factors associated with PPB, whereas endoscopist experience and pre-procedural proton pump inhibitors were not. Second-look endoscopy was not associated with decreased PPB (OR 1.34; 95% CI, 0.85-2.12). CONCLUSIONS: Risk factors for PPB were identified that can help to guide management after gastric ESD, namely adjusting further management. Second-look endoscopy is not associated with decreased PPB.

Journal: Gastrointestinal Endoscopy

Link: http://www.giejournal.org/article/S0016-5107(16)30279-6/abstract