Abstract:

Objective To systematically analyze the risk factors of postoperative hemorrhage of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC). Methods A total of 281 EGC patients who underwent ESD treated in the second Hospital of Hebei Medical University from January 2017 to February 2021 were analyzed retrospectively. These patients were divided into control group and postoperative bleeding group on the basis of occurrence of postoperative hemorrhage. The previous history, inpatient medical records, pathologic diagnosis, report on endoscopy were collected, and the key observation was sex, age, whether or no preoperative antiplatelet therapy, whether with hypertension, diabetes, ischemic angiopathy; tumor location, endoscopic classification, histological classification, tumor diameter, operation time; whether complicated by ulcer, vascular tumor thrombus; whether block resection or complete resection; whether or no postoperative bleeding, as well as the postoperative bleeding time, ect. The risk factors for postoperative hemorrhage of ESD in EGC patients were analyzed by univariate and multivariate Logstic regression. Results There were 16 cases with postoperative bleeding (5.69%, 16/281) in out of 281 EGC patients, with bleeding time was from day 1 to day 9 postoperation; of which 8 cases (50.0%, 8/16) had postoperative bleeding within 24 hours, 10 cases (62.5%, 10/16) had postoperative bleeding within 48 hours, 1 patient had two consecutive bleeding within 48 hours, and 1 patient developed hemorrhagic shock, those patients successed in hemostasis under endoscope.The independent risk factor for postoperative hemorrhage of ESD in EGC patients was preoperative antiplatelet therapy (OR=0.051, 95% CI 0.011-0.230, P<0.01), operation time ≥2 hours (OR=0.048, 95% CI 0.009-0.263, P<0.01) and complication by ulcer (OR=0.038, 95% CI 0.007-0.193, P<0.01). Conclusion Independent risk factor for postoperative hemorrhage of ESD in EGC patients was operation time more than 2 hours, preoperative antiplatelet therapy, complication by ulcer.

Key words: stomach neoplasms, endoscopic submucosal dissection, postoperative bleeding