Su1487 Impact of Diabetes Mellitus on Postoperative Bleeding After Endoscopic Submucosal Dissection for Esophago-Gastric Tumor

Abstract

Su1487 Impact of Diabetes Mellitus on Postoperative Bleeding After Endoscopic Submucosal Dissection for Esophago-Gastric Tumor Yu Sasaki*, Yasuhiko Abe, Kazuya Yoshizawa, Takeshi Sato, Eiki Nomura, Daisuke Iwano, Makoto Yagi, Kazuhiro Sakuta, Rika Shibuya, Naoko Mizumoto, Nana Kanno, Shoichi Nishise, Yoshiyuki Ueno Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan Metabolic syndrome has been more widespread due to a rise in obesity rates among adults. We have thus increased opportunities to perform endoscopic submucosal dissection (ESD) for patients with esophago-gastric tumors complicated with type 2 diabetes (DM), hypertension (HT) and hyperlipidemia (HL). These patients are at risk for atherosclerosis and often taking antithrombotic agents, which are likely to be risk for bleeding in ESD. However, the potential risk of post-ESD bleeding in these patients was still unclear. Therefore, we investigated whether DM, HT and HL were associated with increased risk of bleeding post-ESD. Methods: 185 consecutive patients, who underwent ESD for 28 esophageal tumors and 159 gastric tumors at Yamagata University Hospital, between January 2009 and December 2011, were enrolled and reviewed retrospectively. ESD was performed by using standard techniques. Antithrombotic agents were interrupted preoperatively with/without using heparin as a bridge therapy, and were restarted when hemostasis was confirmed by second-look endoscopy. All patients were treated with proton pump inhibitors after ESD. Post-ESD bleeding was defined as an episode of any of the following: overt hematemesis/hematochezia; a drop of hemoglobin O2 g/dL; or requirement of endoscopic hemostasis and/or transfusion. The risk of post-ESD bleeding was evaluated by logistic regression analysis. Results: Post-ESD bleeding occurred in 8 patients (4.3%). In comparison with the nonbleeding group, individuals in the postESD bleeding group have had a significantly higher proportion of DM (62.5% vs. 14.8%, p!0.01) and antithrombotic agents usage (50% vs. 15.3%, p Z 0.03). There were no significant differences between the groups in the proportion of male, HT (p Z 0.07) and HL (p Z 0.06). Similarly, no differences were observed in median age, BMI, blood pressure, PT-INR, APTT, counts of platelets and specimen diameter. Univariate analysis indicated that DM (OR, 9.6; 95%CI, 2.16-42.6) had a greater odds ratio (OR) for post-ESD bleeding than antithrombotic agents usage (OR, 5.5; 95%CI, 1.31-23.5). Multivariate-adjusted ORs of post-ESD bleeding for the bleeding group compared with the nonbleeding group were 7.7 (95%CI, 1.68-35.8), 4.1 (95%CI, 0.91-19.2) and 29.5 (95%CI, 5.00-174) for DM, antithrombotic agents usage and DM with antithrombotic agents usage, respectively. Furthermore, none of the patients had thromboembolism. In conclusion, this study suggests that DM is associated with the risk of postoperative bleeding after esophago-gastric ESD. Given that patients with DM carry more comorbidities, ESD should be done more carefully for these patients. To prevent post-ESD bleeding, further studies will be needed to confirm our findings and to elucidate the underlying the mechanisms.