Retrospective Analysis Of Bleeding Risk Factors After Endoscopic Mucosal Dissection Of Early Gastric Cancer

Objective:To explore the risk factors associated with postoperative hemorrhage(PEB)following endoscopic mucosal dissection(ESD)for early gastric cancer,to collect relevant clinical data for analysis,and to systematically analyze the influence factors of postoperative hemorrhage in early gastric cancer through Meta analysis by retrieving relevant literature.Methods:A retrospective investigation was conducted on the patients undergoing ESD treatment for early gastric cancer in endoscopic Center of Qingdao Municipal Hospital from January 1,2016 to May 1,2020,to analyze the risk factors of bleeding after ESD.Chinese search words "early gastric cancer,postoperative bleeding,risk factors,endoscopic mucosal dissection" were used.English Key Words: "ESD" OR "Mucosal Resection,Meanwhile,meanwhile,cashmere cashmere,cashmere cashmere,cashmere cashmere,cashmere cashmere,cashmere cashmere,cashmere cashmere,cashmere cashmere Subsuperiority,Blood Loss,Postoperative Blood,Postoperative Blood Loss,Hemo 335,Search words such as "Postoperative OR Postoperative",The retrieval databases included cn KI,WANfang,Chinese Biomedical literature database,Pubmed,Embase,Google Academic,Cochrane,Web of Science and other articles on PEB in early gastric tumorgenesis.The retrieval period was from January 01,2010 to May 01,2021.The quality of the obtained literatures was evaluated using the newcastle-ottawa scale(NOS),and the statistical software SPSS23.0 and Rev Man5.3 were used for relevant statistical analysis.Results:A total of 237 study cases were collected according to inclusion and exclusion criteria,and postoperative bleeding occurred in 13 cases,with a bleeding rate of 5.4%.Univariate analysis showed that the size of lesion,whether the lesion was ≥2 lesions,positive gastric ulcer,history of cirrhosis,history of malignant tumor,history of aspirin medication,history of clopidogrel medication,history of dual antiplatelet medication were related to bleeding after Endoscopic submucosal dissection.Multivariate analysis showed that positive gastric ulcer,resection lesion size,history of malignant tumor,and history of dual antiplatelet drug use were risk factors for bleeding after ESD.Meta analysis results,through the preliminaryaccess database in both English and Chinese with 7842 references,through strict screening,were included in the standard 9 articles,the object of study of 5719 cases occurred PEB 282cases(4.95%).Meta-analysis showed that: male(OR: 1.73,95%CI: 1.26-2.37),gastric ulcer positive(OR: 1.83,95%CI: 1.04-3.22),antithrombotic drugs(OR: 2.17,95%CI: 1.65-2.86),operation time(MD: 12.48,95%CI: 1.72-23.23),resection lesion size(MD: 5.30,95%CI:3.32-7.29)and invasion depth(OR: 1.53,95%CI: 1.04-2.26)were risk factors for early gastric cancer PEB.Conclusion:Analysis of included clinical data showed that lesion size,history of gastric ulcer,history of malignant tumor,and history of dual antiplatelet drug use were significantly correlated with bleeding after ESD,and were independent risk factors for bleeding after ESD.Meta analysis showed that masculinity,positive gastric ulcers,antithrombotic drugs,duration of operation,size of lesion removed and depth of infiltration were independent risk factors for bleeding after ESD treatment,especially in patients treated with antithrombotic agents.