The Analysis Of The Risk Factors Of Delayed Bleeding After Gastrointestinal ESD

Objective: Delayed bleeding is one of the major complications after endoscopic submucosal dissection(ESD).Appropriate preoperative assessment and postoperative management are effective measures to prevent and treat delayed bleeding.The aim of this study is to analyze the risk factors associated with delayed bleeding after ESD for the treatment of gastrointestinal mucosal lesions and to optimize preoperative risk assessment and postoperative management to reduce postoperative delayed bleeding.Methods: 313 patients who underwent ESD surgery for gastrointestinal mucosal lesions from 2015 to 2017 in Wuhan Union Hospital were involved in this study.This patients were divided into bleeding group and non-bleeding group.Possible risk factors were statistically analyzed,including: pathological type,the size of the lesion,the location of the lesion,gender,age,family history of gastrointestinal cancer,comorbidities(cardiovascular disease,chronic liver disease,diabetes mellitus),smoking history,drinking history.In addition,patients whose lesion were located in the upper digestive tract were divided as different intake of proton pump inhibitors(PPIs)in 24 hours after operation,and the PPIs intake was statistically analyzed.Results:Of the 313 patients,21(6.7%)had delayed postoperative bleeding,including 2(2.2%)in esophagus,12(6.6%)in the stomach,7(18.4%)in the intestine;among that,13 had bleeding after operation in 3 to 4 days(61.9%),3 had bleeding in a week or so(14.3%),and 5 had bleeding(23.8%)1 to 2 days after operation.All of them were successfully stopped by medical conservative treatment or endoscopic treatment.Univariate and multivariate logistic regression analysis was performed on 313 cases.The results showed that the size of lesions were ≥3 cm(P=0.002,OR=4.689,95%CI 1.763 ~ 12.470)and combining with chronic liver disease(P=0.024,OR=4.542,95%CI 1.226 ~ 16.834),the lesion located in the intestine(P=0.002,OR=5.588,95%CI 1.917 ~ 16.294)were risk factors for postoperative delayed bleeding.Univariate analysis of 275 cases of lesions in the upper digestive tract showed no significant correlation between different intake of PPIs in 24 hours after operation(P=0.120)and delayed bleeding.Multivariate analysis showed the size of lesions were ≥3 cm(P=0.003,OR=5.735,95%CI 1.788 ~ 18.399)and combining with chronic liver disease(P=0.026,OR=5.280,95%CI 1.224 ~ 22.776)are risk factors for postoperative delayed bleeding.Conclusion: ESD is currently the first-line minimally invasive surgery for the treatment of gastrointestinal mucosal lesions.the size of lesions were ≥3 cm,the patient with chronic liver disease and the lesion located in the intestine are risk factors for postoperative delayed bleeding.Increasing the PPIs intake in 24 hours after surgery on a standard dose did not reduce the risk of delayed bleeding.