Analysis On Risk Factors Of Bleeding After Endoscopic Submucosal Dissection Of Early Gastric Cancer

Background and objective: Endoscopic submucosal dissection(ESD)is a commonly used endoscopic procedure.Because it is not limited by tumor size and because of its high cure rate,it has replaced endoscopic mucosal resection(EMR))as the first choice for the treatment of early digestive tract cancer in recent years.Although endoscopic techniques and instruments have been improved since the 1990 s,bleeding is still one of the common complications of ESD.In particular,postoperative bleeding has perplexed many clinicians because of its sudden and unpredictable characteristics.In this paper,we will systematically analyze the risk factors of bleeding after ESD of early gastric cancer.Methods: A total of 281 patients with early gastric cancer who underwent endoscopic submucosal dissection in the endoscopic room of the second Hospital of Hebei Medical University from January 2017 to February 2021 were analyzed retrospectively.According to the occurrence of postoperative bleeding,the patients were divided into control group and postoperative bleeding group.The data of past history,hospitalization history,pathological results and endoscopic reports were collected.Statistics and analysis of the patient’s sex,age,whether taking antiplatelet drugs in the past 1 month,hypertension,diabetes,ischemic vascular disease,tumor location,endoscopic gross classification,histological type,tumor diameter,operation time,whether complicated with ulcer,whether complicated with vascular tumor thrombus,whether it is block resection,whether it is complete resection,Whether there is postoperative bleeding and the time of postoperative bleeding and other information for statistical analysis.The risk factors of bleeding after ESD inpatients with early gastric cancer were analyzed by univariate and multivariate Logstic regression.Results: Of the 281 patients with early gastric cancer,16 had postoperative bleeding(5.69%).The bleeding time was from the 1st day to the 9th day after operation.Among them,8 cases(50.0%)had postoperative bleeding within 24 hours,10 cases(62.5%)had postoperative bleeding within 48 hours,1 patient had 2 consecutive bleeding within 48 hours,and 1 patient developed hemorrhagic shock,all of which successfully stopped bleeding under endoscope.Univariate and multivariate analysis showed that taking antiplatelet drugs within one month before operation(OR = 11.608,95% CI2.849,46.584,P < 0.001),operation time ≥ 4 hours(OR = 10.471,95% CI3.87,33.333,P < 0.001)and Complication of ulcer(OR = 14.213,95% CI3.805,54.595,P < 0.001)were independent risk factors for bleeding after early gastric cancer.Conclusion: Operation time ≥ 4 hours,application of antiplatelet drugs within 1 month before operation,Complication of ulcer are independent risk factors of bleeding after ESD in patients with early gastric cancer.