Risk Factors Related to Bleeding in Gastric Tumors after Endoscopic Mucosal Resection

Abstract

Background/Aim: Endoscopic mucosal resection (EMR) has been widely used for treatment of gastric mucosal tumors because of safety and minimal invasiveness. But the bleeding after EMR has often caused trouble, and it has been regarded as a major complication. Recently, EMR has also been performed on other lesions than conventional indication of EMR, so it is accounted what factors are related to bleeding. We assessed bleeding rates and risk factors related to bleeding after EMR. Methods: We analyzed retrospectively 249 patients with 283 lesions who underwent EMR for flat adenoma (78.8%), hyperplastic polyp (4.9%), and early gastric cancer (16.3%) from January 1999 to August 2003. Male was 161 (64.7%) and female 88 (35.3%), and mean age was 61.4 years. Bleeding during EMR was defined immediate bleeding, bleeding on follow-up endoscopy after EMR was defined delayed bleeding, and bleeding which need to transfusion and angioembolization was defined major bleeding. We followed up endoscopy at one day after EMR. We evaluated risk factors related to bleeding, using univariate and multivariate analysis. Three cases of perforation were excluded. Results: Bleeding after EMR occurred totally in 99 patients (35%). Immediate bleeding occurred in 31.8% and more frequently in case of beginners, upper part, lesions larger than 2cm, or EMR by needle knife. Delayed bleeding occurred in 8.1% and more frequently in case of flat or depressed lesions, carcinoma, piecemeal resection, and occurrence of immediate bleeding. Major bleeding occurred in 10 patients (3.5%). Risk factors related to post-EMR bleeding were experience of operator (beginner vs. expert, p=0.001), anatomical location (body vs. antrum, p=0.009), and method of procedure (needle knife vs. snare or band, p=0.001). Conclusion: Our report showed that the incidence of delayed bleeding was low compared to that of immediate bleeding. We recommend cautious endoscopic management after EMR to prevent bleeding according to experience of operator, anatomical location, and method of procedure.