Analysis Of Risk Factors And Risk Assessment Model Of Delayed Bleeding After Gastric Endoscopic Submucosal Dissection

ObjectiveDelayed bleeding is one of the main complications after gastric endoscopic submucosal dissection(ESD).The purpose is to investigate the risk factors for delayed bleeding after ESD of gastric lesions and to establish a risk assessment model for predicting delayed bleeding.MethodsRetrospective analysis was conducted on the clinical data of patients receiving ESD treatment for gastric lesions in the Zhong Da hospital of southeast university from February 2014 to October2019,and a total of 1472 patients were included.Patients were randomly divided into the derivation group and the validation group,accounting for 80% and 20% of the total sample content.Using the data from the derivation group,the independent risk factors of delayed bleeding after gastric ESD can be studied by using univariate analysis and multivariate logistic regression analysis.Based on the β coefficient of multivariate logistic regression model,weight was assigned to each risk factor and a risk assessment model was established to predict delayed bleeding.Finally,the practicability of the risk assessment model is tested and evaluated with the data of the validation group.Results1.A total of 1472 patients were included in the study,of which 86 cases(5.84%)had delayed bleeding after the operation.Among them,56 cases(65.1%)had bleeding within 48 hours after the operation,and 30 cases(34.9%)had bleeding after 48 hours,with an average of(3.7±4.2)days.According to the random method,they were divided into two groups: the derivation group: a total of 1177 cases(1177/1472,80%),the validation group: a total of 295 cases(295/1472,20%);2.Univariate analysis was conducted on the related factors of delayed bleeding after ESD,and the results showed that patients with hypertension,previous use of plavix or talcom,the lesion in the lower third of the stomach,lesion size≥20mm,resection size≥40mm,and ulcer or scar were significantly correlated with delayed bleeding after ESD(P<0.05).Then,univariate Logistic analysis was performed on the data to obtain the risk factors with P<0.1,and multivariate Logistic regression analysis was performed on these risk factors.The final results showed that risk factors for delayed bleeding after gastric ESD included previous use of plavix or talcom,the lesion in the lower third of the stomach,the resection size ≥40mm and ulcer or scar(P<0.05).3.Based on the β coefficient of multivariate logistic regression model,score the above four risk factors,and an evaluation model with a total score of 6 points was obtained.This model predicted the data of the derivation group,the area under the Receiver Operating Characteristic(ROC)curve is 0.714(95%Cl: 0.649-0.778)(P<0.001).The risk assessment model was tested and evaluated in the validation group,and the area under the ROC curve was 0.710(95%Cl:0.592-0.829).Conclusion1.Four risk factors,including previous use of plavix or talcom,the lesion in the lower third of the stomach,the resection size ≥40mm and ulcer or scar are independent risk factors for delayed bleeding after ESD.2.The risk assessment model established based on the above four risk factors can be used to predict the risk degree of delayed bleeding after gastric ESD,and has good accuracy and credibility through external verification.For patients with higher risk scores,the occurrence of delayed bleeding should be carefully prevented during perioperative period.