Brief Article
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 21, 2014; 20(7): 1839-1845
Published online Feb 21, 2014. doi: 10.3748/wjg.v20.i7.1839
Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms
Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masaaki Matsuura, Takao Itoi, Takuji Gotoda, Masahiro Igarashi, Fuminori Moriyasu
Sho Suzuki, Akiko Chino, Teruhito Kishihara, Naoyuki Uragami, Yoshiro Tamegai, Takanori Suganuma, Junko Fujisaki, Masahiro Igarashi, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Sho Suzuki, Takao Itoi, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan
Masaaki Matsuura, Bioinformatics Group, Genome Center, and Division of Cancer Genomics, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Author contributions: Suzuki S and Chino A wrote the manuscript and performed most of the research; Chino A, Kishihara T, Uragami N, Tamegai Y, Suganuma T, Fujisaki J and Igarashi M performed the endoscopic procedure and supported the research; Itoi T, Gotoda T and Moriyasu F drafted and revised the manuscript; Matsuura M designed the study and was involved in statistical analysis.
Correspondence to: Sho Suzuki, MD, Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan. sho.suzuki@jfcr.or.jp
Telephone: +81-3-35200111 Fax: +81-3-35200141
Received: August 21, 2013
Revised: November 14, 2013
Accepted: January 2, 2014
Published online: February 21, 2014
Processing time: 203 Days and 1.8 Hours
Abstract

AIM: To investigate the risk factors for delayed bleeding following endoscopic submucosal dissection (ESD) treatment for colorectal neoplasms.

METHODS: We retrospectively reviewed the medical records of 317 consecutive patients with 325 lesions who underwent ESD for superficial colorectal neoplasms at our hospital from January 2009 to June 2013. Delayed post-ESD bleeding was defined as bleeding that resulted in overt hematochezia 6 h to 30 d after ESD and the observation of bleeding spots as confirmed by repeat colonoscopy or a required blood transfusion. We analyzed the relationship between risk factors for delayed bleeding following ESD and the following factors using univariate and multivariate analyses: age, gender, presence of comorbidities, use of antithrombotic drugs, use of intravenous heparin, resected specimen size, lesion size, lesion location, lesion morphology, lesion histology, the device used, procedure time, and the presence of significant bleeding during ESD.

RESULTS: Delayed post-ESD bleeding was found in 14 lesions from 14 patients (4.3% of all specimens, 4.4% patients). Patients with episodes of delayed post-ESD bleeding had a mean hemoglobin decrease of 2.35 g/dL. All episodes were treated successfully using endoscopic hemostatic clips. Emergency surgery was not required in any of the cases. Blood transfusion was needed in 1 patient (0.3%). Univariate analysis revealed that lesions located in the cecum (P = 0.012) and the presence of significant bleeding during ESD (P = 0.024) were significantly associated with delayed post-ESD bleeding. The risk of delayed bleeding was higher for larger lesion sizes, but this trend was not statistically significant. Multivariate analysis revealed that lesions located in the cecum (OR = 7.26, 95%CI: 1.99-26.55, P = 0.003) and the presence of significant bleeding during ESD (OR = 16.41, 95%CI: 2.60-103.68, P = 0.003) were independent risk factors for delayed post-ESD bleeding.

CONCLUSION: 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.

Keywords: Adverse event; Bleeding; Colorectal neoplasms; Endoscopic submucosal dissection; Hemorrhage

Core tip: Endoscopic submucosal dissection (ESD) has recently been accepted as an effective treatment for colorectal neoplasms, but the risk factors for bleeding following ESD have not been elucidated. We analyzed the relationship between delayed post-ESD bleeding and various factors related to ESD for colorectal neoplasms. The rate of delayed post-ESD bleeding was 4.3%, and univariate and multivariate analyses showed that the location of lesions in the cecum and the presence of significant bleeding during ESD were significantly associated with delayed post-ESD bleeding. Therefore, patients with these risk factors should be carefully managed with additional interventions if necessary.