Original Articles
Predictors of bleeding after endoscopic mucosal resection of gastric tumors☆,☆☆

https://doi.org/10.1067/mge.2003.192Get rights and content

Abstract

Background: Endoscopic mucosal resection has been increasingly used to treat gastric tumors. Bleeding is the major complication of endoscopic mucosal resection. This study evaluated risk factors for bleeding associated with endoscopic mucosal resection. Methods: Four hundred seventy-seven patients who underwent endoscopic mucosal resection of gastric tumors during the past 10 years were studied retrospectively. Bleeding encountered during endoscopic mucosal resection was termed immediate; bleeding after endoscopic mucosal resection was termed delayed. Univariate and multivariate analyses were used for determination of the factors related to delayed bleeding. One case of perforation was excluded. Results: Delayed bleeding occurred in 25 (5.3%) of 476 patients. The only factor found to be significantly different between cases with and without delayed bleeding was the occurrence of immediate bleeding during endoscopic mucosal resection (p < 0.001). Sites where immediate bleeding occurred were not the same as those where delayed bleeding arose. There were no significant differences in other factors. Conclusions: When immediate bleeding occurs during endoscopic mucosal resection, there is an increased risk of delayed bleeding. (Gastrointest Endosc 2003;57:687-90.)

Section snippets

Patients and methods

EMR was performed in 477 patients with gastric tumors (504 lesions) at our hospital between January 1991 and December 2000. The 504 lesions consisted of 179 early stage gastric cancers, 296 adenomas, and 29 submucosal tumors (SMTs). Indications for EMR included intramucosal differentiated adenocarcinoma without ulceration or fibrosis in the submucosal layer and adenoma. Cancers treated were less than 20 mm in maximum diameter for protruded, superficial-elevated, and superficial-flat type

Results

Delayed bleeding occurred in 25 (5.3%) of 476 patients; one patient in whom a perforation occurred was excluded. Bleeding (oozing in 23 and pulsating in 2) was diagnosed endoscopically between 6 and 166 hours (median, 33 hours; [17-69]) after EMR. In 23 of 25 cases, bleeding arose from exposed vessels in the center of an ulcer. In all cases except one, bleeding was controlled endoscopically by injection of a hypertonic saline-epinephrine (HSE) solution, electrocoagulation, or clip application.

Discussion

Postoperative bleeding is the main complication of EMR of gastric tumors. The reported rate ranges from 0.38% to 16.1%.5, 6, 13, 14, 15, 16 National surveys by the Japanese Society of Gastroenterological Endoscopy published in 1995 and 2000 found the complication rate for EMR in the stomach to be, respectively, 0.38%13 and 0.51%.14 Rates of EMR-associated bleeding reported from various institutions are 16.1%, 10.2%, 14.3%, and 10.5%.5, 6, 15, 16 Immediate bleeding was included in these reports.5

References (18)

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Reprint requests: Akihiro Okano, MD, Department of Gastroenterology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.

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0016-5107/2003/$30.00 + 0

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Copyright © 2003 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.