Compared with open surgery performed for early cancer, endoscopic submucosal dissection (ESD) is less burdensome to patients. However, bleeding after ESD (post-bleeding) is known to occur in a few patients. Although comorbidity is an important factor associated with postoperative bleeding, few reports in Japan have discussed the association between renal function decline and post-bleeding. We investigated the effect of diminished renal function on post-bleeding. This retrospective study investigated 403 patients who underwent ESD between April 2016 and April 2018 at the Saku General Hospital Saku Medical Center. Post-bleeding was defined as hemorrhage observed within 10 days after surgery, black stool, serum hemoglobin ≧2 reduction before and after ESD, and endoscopically documented post-bleeding.

　The incidence of post-bleeding was higher in patients aged ≥75 years (P=0.161), in patients receiving ≥6 medications (P <.001), in those using nonsteroidal anti-inflammatory drugs (P=0.195), and proton pump inhibitors/H2-receptor antagonists (P=0.112), in patients with SeGFR <60 using antiplatelet drugs alone (P=0.122), those with SeGFR ≧60 or SeGFR <60 using anticoagulants alone (P=0.086, P=0.002), in those with SeGFR <60 using antiplatelet +anticoagulant medications (P=0.023), and in patients with hypertension (P=0.119). Multivariate analysis showed that SeGFR <60 and use of anticoagulants alone (odds ratio 8.39, 95% confidence interval 2.57-27.4) were significantly associated with post-bleeding. These results suggest that anticoagulant use was a risk factor for post-bleeding. No significant association was observed between renal dysfunction and post-bleeding; however, renal dysfunction may increase the risk of hemorrhage. Therefore, this study suggests that patients with renal dysfunction should be carefully monitored to prevent post-bleeding.