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Rebleeding in patients with delayed bleeding after endoscopic submucosal dissection for early gastric cancer.

Authors :
Hashimoto M
Hatta W
Tsuji Y
Yoshio T
Yabuuchi Y
Hoteya S
Doyama H
Nagami Y
Hikichi T
Kobayashi M
Morita Y
Sumiyoshi T
Iguchi M
Tomida H
Inoue T
Mikami T
Hasatani K
Nishikawa J
Matsumura T
Nebiki H
Nakamatsu D
Ohnita K
Suzuki H
Ueyama H
Hayashi Y
Sugimoto M
Fujishiro M
Masamune A
Ohira H
Source :
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society [Dig Endosc] 2021 Nov; Vol. 33 (7), pp. 1120-1130. Date of Electronic Publication: 2021 Mar 17.
Publication Year :
2021

Abstract

Objectives: Delayed bleeding is a major adverse event in endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Some patients may experience rebleeding after successful hemostasis for delayed bleeding, yet the details of rebleeding remain unclear. We aimed to clarify the frequency and risk factors of rebleeding.<br />Methods: Among 11,452 patients who underwent ESD for EGC at 33 institutions in Japan between 2013 and 2016, we analyzed 489 patients showing delayed bleeding. The rate of rebleeding was investigated. Subsequently, 15 candidate variables were evaluated for their influence on the risk of rebleeding via logistic regression analysis.<br />Results: Rebleeding occurred in 11.2% (55/489) of the enrolled patients. Multivariate analysis revealed that warfarin [odds ratio (OR), 2.71; 95% confidence interval (CI), 1.26-5.84] and a resection size >40 mm (OR, 1.99; 95% CI, 1.08-3.67) were independent risk factors for rebleeding. In the analysis of the management of warfarin after index bleeding, only warfarin discontinuation (OR, 3.66; 95% CI, 1.37-9.78) was significantly associated with rebleeding in comparison with no use of warfarin. However, many rebleeding events (75.0%) occurred following the resumption of warfarin. The rebleeding rate during discontinuation status and that in taking warfarin (continuation or resumption) were 6.1% and 20.0%, respectively.<br />Conclusions: Rebleeding was not a rare event in patients experiencing delayed bleeding after ESD for EGC. In addition to having a resection size >40 mm, warfarin usage placed patients at high risk for rebleeding, especially at the timing of its resumption following discontinuation as well as its continuation.<br /> (© 2021 Japan Gastroenterological Endoscopy Society.)

Details

Language :
English
ISSN :
1443-1661
Volume :
33
Issue :
7
Database :
MEDLINE
Journal :
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
Publication Type :
Academic Journal
Accession number :
33539035
Full Text :
https://doi.org/10.1111/den.13943