Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor

Jae Woo Kim, Hyunsoo Kim, Dong Hoon Park, Yong Soon Park, Myeong Gwan Jee, Soonkoo Baik, Sang Ok Kwon, DongKi Lee

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE: Although endoscopic mucosal resection has been recognized as the standard treatment for gastric mucosal neoplasm, postendoscopic mucosal resection hemorrhage remains a major complication of endoscopic mucosal resection, and this problem seems to be increasing owing to the development of invasive techniques. The aims of this study were to determine the incidence and grade of postendoscopic mucosal resection hemorrhage and to identify risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric neoplasm. METHODS: Data of endoscopic mucosal resections performed by three endoscopists were retrospectively collected over 8 years and then analyzed. Immediate postendoscopic mucosal resection hemorrhage was defined as bleeding during the procedure. Delayed postendoscopic mucosal resection hemorrhage was defined when two of the four following parameters were satisfied after the endoscopic mucosal resection period; (i) hematemesis, melena or dizziness, (ii) hemoglobin loss >2 g/dl, (iii) blood pressure decrease >20 mmHg or pulse rate increase >20/min and (iv) Forrest I or IIa-IIb on follow-up endoscopy. RESULTS: A total of 157 patients (mean age: 64 years, male : female=44 : 113) were reviewed. Twenty-nine (18.5%) and 13 patients (8.3%) presented with immediate and delayed postendoscopic mucosal resection hemorrhage, respectively. Multivariate logistic regression analysis revealed that the patient's age (≤65 years; odds ratio 6.11, 95% confidence interval 1.12-33.43), the size of lesion (>15 mm; odds ratio 5.90, 95% confidence interval 1.13-30.87) and the experience of the endoscopist (≤5 years; odds ratio 16.31, 95% confidence interval 1.46-181.97) were significantly predictive variables for the delayed postendoscopic mucosal resection hemorrhage. CONCLUSION: Considering the higher risk of delayed postendoscopic mucosal resection hemorrhage, careful preparation and close monitoring are required for patients who are less than 65 years, have large lesions over 15 mm or if the procedures were performed by an inexperienced endoscopist.

Original languageEnglish
Pages (from-to)409-415
Number of pages7
JournalEuropean Journal of Gastroenterology and Hepatology
Volume19
Issue number5
DOIs
Publication statusPublished - 2007 May 1

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Stomach
Hemorrhage
Neoplasms
Odds Ratio
Confidence Intervals
Stomach Neoplasms
Melena
Hematemesis
Physiologic Monitoring
Dizziness
Endoscopy
Hemoglobins
Heart Rate
Logistic Models
Regression Analysis
Blood Pressure
Endoscopic Mucosal Resection
Incidence

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Kim, Jae Woo ; Kim, Hyunsoo ; Park, Dong Hoon ; Park, Yong Soon ; Jee, Myeong Gwan ; Baik, Soonkoo ; Kwon, Sang Ok ; Lee, DongKi. / Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor. In: European Journal of Gastroenterology and Hepatology. 2007 ; Vol. 19, No. 5. pp. 409-415.
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title = "Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor",
abstract = "OBJECTIVE: Although endoscopic mucosal resection has been recognized as the standard treatment for gastric mucosal neoplasm, postendoscopic mucosal resection hemorrhage remains a major complication of endoscopic mucosal resection, and this problem seems to be increasing owing to the development of invasive techniques. The aims of this study were to determine the incidence and grade of postendoscopic mucosal resection hemorrhage and to identify risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric neoplasm. METHODS: Data of endoscopic mucosal resections performed by three endoscopists were retrospectively collected over 8 years and then analyzed. Immediate postendoscopic mucosal resection hemorrhage was defined as bleeding during the procedure. Delayed postendoscopic mucosal resection hemorrhage was defined when two of the four following parameters were satisfied after the endoscopic mucosal resection period; (i) hematemesis, melena or dizziness, (ii) hemoglobin loss >2 g/dl, (iii) blood pressure decrease >20 mmHg or pulse rate increase >20/min and (iv) Forrest I or IIa-IIb on follow-up endoscopy. RESULTS: A total of 157 patients (mean age: 64 years, male : female=44 : 113) were reviewed. Twenty-nine (18.5{\%}) and 13 patients (8.3{\%}) presented with immediate and delayed postendoscopic mucosal resection hemorrhage, respectively. Multivariate logistic regression analysis revealed that the patient's age (≤65 years; odds ratio 6.11, 95{\%} confidence interval 1.12-33.43), the size of lesion (>15 mm; odds ratio 5.90, 95{\%} confidence interval 1.13-30.87) and the experience of the endoscopist (≤5 years; odds ratio 16.31, 95{\%} confidence interval 1.46-181.97) were significantly predictive variables for the delayed postendoscopic mucosal resection hemorrhage. CONCLUSION: Considering the higher risk of delayed postendoscopic mucosal resection hemorrhage, careful preparation and close monitoring are required for patients who are less than 65 years, have large lesions over 15 mm or if the procedures were performed by an inexperienced endoscopist.",
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Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor. / Kim, Jae Woo; Kim, Hyunsoo; Park, Dong Hoon; Park, Yong Soon; Jee, Myeong Gwan; Baik, Soonkoo; Kwon, Sang Ok; Lee, DongKi.

In: European Journal of Gastroenterology and Hepatology, Vol. 19, No. 5, 01.05.2007, p. 409-415.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor

AU - Kim, Jae Woo

AU - Kim, Hyunsoo

AU - Park, Dong Hoon

AU - Park, Yong Soon

AU - Jee, Myeong Gwan

AU - Baik, Soonkoo

AU - Kwon, Sang Ok

AU - Lee, DongKi

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AB - OBJECTIVE: Although endoscopic mucosal resection has been recognized as the standard treatment for gastric mucosal neoplasm, postendoscopic mucosal resection hemorrhage remains a major complication of endoscopic mucosal resection, and this problem seems to be increasing owing to the development of invasive techniques. The aims of this study were to determine the incidence and grade of postendoscopic mucosal resection hemorrhage and to identify risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric neoplasm. METHODS: Data of endoscopic mucosal resections performed by three endoscopists were retrospectively collected over 8 years and then analyzed. Immediate postendoscopic mucosal resection hemorrhage was defined as bleeding during the procedure. Delayed postendoscopic mucosal resection hemorrhage was defined when two of the four following parameters were satisfied after the endoscopic mucosal resection period; (i) hematemesis, melena or dizziness, (ii) hemoglobin loss >2 g/dl, (iii) blood pressure decrease >20 mmHg or pulse rate increase >20/min and (iv) Forrest I or IIa-IIb on follow-up endoscopy. RESULTS: A total of 157 patients (mean age: 64 years, male : female=44 : 113) were reviewed. Twenty-nine (18.5%) and 13 patients (8.3%) presented with immediate and delayed postendoscopic mucosal resection hemorrhage, respectively. Multivariate logistic regression analysis revealed that the patient's age (≤65 years; odds ratio 6.11, 95% confidence interval 1.12-33.43), the size of lesion (>15 mm; odds ratio 5.90, 95% confidence interval 1.13-30.87) and the experience of the endoscopist (≤5 years; odds ratio 16.31, 95% confidence interval 1.46-181.97) were significantly predictive variables for the delayed postendoscopic mucosal resection hemorrhage. CONCLUSION: Considering the higher risk of delayed postendoscopic mucosal resection hemorrhage, careful preparation and close monitoring are required for patients who are less than 65 years, have large lesions over 15 mm or if the procedures were performed by an inexperienced endoscopist.

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