Endoscopy 2008; 40(3): 179-183
DOI: 10.1055/s-2007-995530
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection - An analysis of risk factors[*]

K.  Takizawa1 , I.  Oda1 , T.  Gotoda1 , C.  Yokoi1 , T.  Matsuda1 , Y.  Saito1 , D.  Saito1 , H.  Ono2
  • 1Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
  • 2Endoscopy Division, Shizuoka Cancer Center Hospital, Shizuoka, Japan
Further Information

Publication History

submitted 10 April 2006

accepted after revision 16 October 2007

Publication Date:
06 March 2008 (online)

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.

1 Presented at the 13th United European Gastroenterology Week, UEGW 2005, Copenhagen, Denmark, 15 - 19 October 2005.

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1 Presented at the 13th United European Gastroenterology Week, UEGW 2005, Copenhagen, Denmark, 15 - 19 October 2005.

Ichiro Oda, MD 

Endoscopy Division
National Cancer Center Hospital

5-1-1 Tsukiji, Chuo-ku
Tokyo 104-0045
Japan

Fax: +81-3-3542-3815

Email: ioda@ncc.go.jp