Risk Factors Of Intraoperation Hemorrhage During Endoscopic Submucosal Dissection For Early Digestive Cancer Or Precancerous Lesions

Background:Endoscopic Submucosal Dissection(ESD)has become one of the most important therapy for digestive tract diseases,especially for the treatment of early stage tumors and precancerous lesions of the digestive tract.Common complications of ESD include bleeding,perforation,postoperative stenosis,and recurrence.ESD-related bleeding includes intraoperative bleeding and postoperative delayed bleeding.Intraoperative bleeding of ESD is a common complication.Objective:The study aimed to analysis the risk factors for intraoperative bleeding of ESD for early cancer and precancerous lesions of the digestive tract.Methods:This is a retrospective study to analysis the patients who underwent ESD for gastrointestinal mucosa and submucosal lesions in the First Affiliated Hospital of Nanchang University from January 2016 to December 2018.Patients was divided into bleeding group and non-bleeding group.The data of patient-related factors(age,sex,underlying disease and the history of using anti-coagulation and anti-platelet aggregation drug),pathological factors(lesion location,lesion size,depth of lesion infiltration,postoperative pathological results),operation time were collected.Univariate and multivariate logistic regression were used to analyze independent risk factors for intraoperative bleeding of ESD.Results:A total of 588 patients were enrolled including 201 patients with cancerous changes(154 cases of intramucosal cancer and 47 cases of submucosal cancer)、387 patients with dysplasia(280 cases of low-grade epithelial tumors and 107 cases of high-grade epithelial tumors).There were 360(61%)males with a median age of 61(15)years.A total of 52 patients developed ESD intraoperative bleeding,and the incidence of bleeding during ESD was 8.84%.Patients were divided into bleeding group(n=52)and non-bleeding group(n=536)according to whether the patient had ESD intraoperative bleeding.Multivariate logistic regression analysis showed that with a history of diabetes(OR: 3.80;95%CI: 1.07-13.42;P< 0.05),when referenced to colon,the lesion was located in the esophagus(OR: 6.43;95%CI: 1.27-32.63;P< 0.05)and in the rectum(OR: 5.57;95%CI: 1.18-26.21;P< 0.05),the lesion size was ≥6cm(OR: 4.35;95%CI: 1.54-12.32;P< 0.05),the lesions infiltrated into the submucosa(OR: 3.36;95%CI: 1.42-7.96;P< 0.05),the postoperative pathological type was intramucosal carcinoma(OR: 4.66;95%CI: 1.91-11.41;P< 0.05)were independent risk factors for bleeding during ESD.Conclusions:with a history of diabetes,when referenced to colon,the lesion was located in the esophagus and in the rectum,the lesion size was ≥6cm,the lesions infiltrated into the submucosa,the postoperative pathological type was intramucosal carcinoma were independent risk factors for bleeding during ESD.