Risk Factors for Post-gastric Endoscopic Submucosal Dissection Bleeding with a Special Emphasis on Anticoagulant Therapy

• Published in: Digestive diseases and sciences Vol. 65; no. 2; pp. 557 - 564
• Main Authors: Toya, Yosuke, Endo, Masaki, Oizumi, Tomofumi, Akasaka, Risaburo, Yanai, Shunichi, Kawasaki, Keisuke, Nakamura, Shotaro, Eizuka, Makoto, Fujita, Yasuko, Uesugi, Noriyuki, Sugai, Tamotsu, Matsumoto, Takayuki
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2020; Springer; Springer Nature B.V
• Subjects: Anticoagulants; Anticoagulants (Medicine); Biochemistry; Endoscopy; Gastric cancer; Gastroenterology; Health risk assessment; Hepatology; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Oncology; Original Article; Risk factors; Stomach cancer; Surgery; Transplant Surgery; Propensity score matching; Anticoagulants; Endoscopic submucosal dissection; Gastric cancer
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-019-05776-3

Background
Little is known about the risk factors for post endoscopic submucosal dissection (post-ESD) bleeding with anticoagulant therapy.
Aims
We aimed to investigate the risk factors for post-ESD bleeding for early gastric cancer (EGC) with an emphasis on anticoagulant therapy.
Methods
We retrospectively analyzed 2355 EGCs, including 137 lesions in patients treated under anticoagulants. Clinicopathological findings were evaluated between lesions in patients with and without anticoagulant therapy with propensity score matching analysis. The factors associated with post-ESD bleeding were analyzed with multivariate analysis with a logistic regression method.
Results
After propensity score matching, post-ESD bleeding was significantly more frequent in lesions of patients with than without anticoagulant therapy (11.7% vs 1.5%, respectively;
P 
= 0.001). A univariate analysis revealed that anticoagulant therapy, heparin bridge therapy, undifferentiated type, deep submucosal invasion, and resected specimen size were associated with post-ESD bleeding. A multivariate analysis revealed anticoagulant therapy (OR 23.1, 95% CI 3.61–147.52) and resected specimen size (OR 1.03, 95% CI 1.00–1.06) to be independent factors associated with post-ESD bleeding.
Conclusions
Anticoagulant therapy and resected specimen size were risk factors associated with post-ESD bleeding for EGC.