Meta-analysis Of Risk Factors For Delayed Postoperative Bleeding After Endoscopic Submucosal Dissection For Early Gastric Cancer And Precancerous Lesions

Objective:To systematically evaluate the risk factors of delayed bleeding for early gastric cancer and precancerous lesion after endoscopic submucosal dissection(ESD)by means of meta-analysis.Methods:The computer retrieved Pub Med,Web of science,Embase,CBM,CNKI,Wanfang Database,and VIP to retrieve and extract case data related to ESD treatment of early gastric cancer and precancerous lesions and postoperative delayed bleeding,and calculated OR value and 95%CI by Rev Man5.3 statistical software for meta-analysis.Results:A total of 16 studies with a total of 594 patients with PEB were included,and the meta-analysis results showed that:(1)patients with excision specimens≥40 mm in diameter were more likely to develop delayed bleeding after ESD,OR=3.23 in PEB group,95%CI:1.91-5.46,P<0.0001,the difference was statistically significant;(2) patients with lesion size≥30 mm were more likely to develop delayed bleeding after ESD treatment,OR=1.92 in PEB group,95%CI:1.21-3.06,P=0.006,the difference was statistically significant;(3)patients with antithrombotic drugs were more likely to develop postoperative delayed bleeding after ESD,PEB group OR=2.73,95%CI:2.01-3.70,P<0.00001,the difference was statistically significant.(4)Patients with lesions located in the lower and middle of the stomach were more likely to have delayed bleeding after ESD,OR=1.99 in the PEB group,95%CI:1.46-2.71,P<0.0001,the difference was statistically significant;(5)patients with ulcers were more likely to have delayed bleeding after ESD onset,OR=4.17 in the PEB group,95%CI:2.23-7.80,P<0.00001,the difference was statistically significant.(6)In the comparative study of lesion depth,OR=2.65,95%CI:0.82-8.57,P<0.10,the difference was not statistically significant.(7)In the comparison of surgical time and delayed bleeding,the heterogeneity test P=0.0004,I~2=92%,using a random effects model,there was obvious heterogeneity in the literature,and the difference was not statistically significant.Conclusion:Excision of specimens with a diameter of≥40 mm,lesion diameter≥30 mm,a history of antithrombotic drugs,lesions located in the lower and middle of the stomach,and ulcers are significant risk factors for ESD treatment of early gastric cancer and postoperative delayed bleeding after precancerous lesions.