Background and Aim: Many reports suggested that gastric endoscopic submucosal dissection (ESD) technique was associated with higher complication rate compared with conventional endoscopic mucosal resection methods, and immediate or delayed bleeding was a most common complication. Previous studies have also showed the association of several factors such as patient's age, size of specimen, location of the lesion with frequency of bleeding. The purpose of this study was to evaluate the risk factors for additional endoscopic bleeding control during follow-up endoscopy after routine post-ESD coagulation. Methods: We analyzed data of 194 consecutive patients with 216 gastric neoplastic lesions from March 2007 to November 2008. All patients underwent a strict preventive hemostasis with electrocoagulation using coagulation forceps for all visible vessles as well as active bleeding focuses in the resected area. Follow-up endoscopy was performed within 24 to 48 hours after gastric ESD to identify the presence of delayed bleeding. Additional endoscopic bleeding control was performed in cases of active oozing, spurting and exposed large vessels. Various factors related to patients, endoscopic findings, resected specimen and the histologic diagnosis were analyzed as potential risk factors. Results: Additional endoscopic bleeding control was performed in 30 gastric lesions (13.9% of all lesions and 14.4% of patients). Among 30 lesions, 13 lesions (6.0% of all lesions) presented as a significant bleeding, defined as Forrest classification Ia and Ib. Three patients (1.5% of all patients) developed delayed bleeding during 9∼13 days after the procedure. Cancerous lesion was significantly associated with higher rate of significant bleeding during follow-up endoscopy compared with benign lesions such as adenoma and hyperplasic polyp (P = 0.045). Other variables was not associated with frequency of additional bleeding control during follow-up endoscopy. Conclusion: Routine preventive electrocoagulation alleviate known risk factors for delayed bleeding after gastric ESD, and therefore may lead to a lower delayed bleeding rate. In the case of cancer compared with benign lesion, more strict preventive bleeding control may be required because of higher rate of delayed bleeding.
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