The therapeutic effect of endoscopic submucosal dissection and risk factors of bleeding

Abstract

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） for digestive tract mucosal lesions, and risk factor of complications. Methods The data of 154 con secutive patients who underwent ESD for superficial digestive tract mueosal lesions were analyzed prospective ly for therapeutic effect and rate of complications. Risk factors for bleeding was analyzed. Results The en bloc resection rate in 145 completed ESD procedures was 100. 0%. Histologically, complete resection rate was 99. 3%. ESD was not completed in 9 patients due to bleeding （n =5） and perforation （n =4）. Acute massive bleeding occurred in 6 patients （6/154,3.9%）, mild bleeding in 5 （3.2%）, delayed bleeding in 1 （0. 6% ） ,perforation in 4 （2. 6% ） and postESD stenosis in 1 （0. 6% ）. All complications were cured. The postESD uleer healing was achieved in 100% at 8 weeks after treatment. During followup of 10. 6 months （ranged from 8 to 18 months）, no residual or local recurrence was found. Statistic analysis showed in dependent risk factors for bleeding in ESD were lesion location （cardiac fundus） , and lesion size. Conclu sion ESD is an effective and safe procedure in treatment of digestive tract mucosal lesions. The complica tions of ESD are preventable and curable. Strictly controlling operation indications, individualized treatment and the proficient operation skills of physicians are the keys to success. Key words: Endoscopes ; Endoscopic submucosal dissection; Efficiency ; Hemorrhage ; Riskfactors