Influencing factors of postoperative bleeding in endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer

Objective To analyze the possible influencing factors of postoperative bleeding after endoscopic submucosal dissection and endoscopic mucosal resection (ESD/EMR) for early gastric cancer. Methods Clinical data of patients receiving ESD/EMR for the diagnosis of early gastric cancer at the Endoscopy Center of Beijing Friendship Hospital from January 2013 to May 2018, including demographic information (age, gender and history), endoscopic lesion characteristics (tumor size, location and morphology) and postoperative pathological features (differentiated types and invasive depth) were collected to analyze the effects of these factors on bleeding after ESD/EMR. Results A total of 195 patients with early gastric cancer were included in the study and 9 cases (4.6%) had postoperative bleeding. The medication history of clopidogrel and main lesion sizes were statistically different between postoperative bleeding group and non-bleeding group (P=0.018 and P=0.034). Multivariate analysis showed a history of clopidogrel (OR=10.223, 95%CI: 1.143-91.468, P=0.038), multiple lesions (OR=6.412, 95%CI: 1.123-36.616, P=0.037) and lesions sizes of larger than 2 cm (OR=6.718, 95%CI: 1.130-39.935, P=0.036) were possible risk factors for postoperative bleeding. Survival analysis showed of higher postoperative bleeding risks in patients with the history of clopidogrel (P<0.001) and lesions sizes of more than 2 cm (P=0.022). Conclusion More attention should be paid to the risk of ESD/EMR postoperative bleeding in early gastric cancer patients with medication history of clopidogrel and multiple large lesions. Key words: Endoscopic mucosal resection; Risk factors; Endoscopic submucosal dissection; Early gastric cancer; Postoperative bleeding