GASTROENTEROLOGICAL ENDOSCOPY
Online ISSN : 1884-5738
Print ISSN : 0387-1207
ISSN-L : 0387-1207
REBLEEDING IN PATIENTS WITH DELAYED BLEEDING AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER
Minami HASHIMOTOWaku HATTAYosuke TSUJIToshiyuki YOSHIOYohei YABUUCHIShu HOTEYAHisashi DOYAMAYasuaki NAGAMITakuto HIKICHI Masakuni KOBAYASHIYoshinori MORITATetsuya SUMIYOSHIMikitaka IGUCHIHideomi TOMIDATakuya INOUETatsuya MIKAMIKenkei HASATANIJun NISHIKAWATomoaki MATSUMURAHiroko NEBIKIDai NAKAMATSUKen OHNITAHaruhisa SUZUKIHiroya UEYAMAYoshito HAYASHIMitsushige SUGIMOTOMitsuhiro FUJISHIROAtsushi MASAMUNEHiromasa OHIRA
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Supplementary material

2022 Volume 64 Issue 11 Pages 2421-2433

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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.

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.

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 themanagement 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.

Conclusions: Rebleeding was not a rare event in patients experiencing delayed bleeding after ESD for EGC. In addition to having a resection size >40mm, warfarin usage placed patients at high risk for rebleeding, especially at the timing of its resumption following discontinuation as well as its continuation.

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© 2022 Japan Gastroenterological Endoscopy Society
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