Analysis Of Clinical Risk Factors Of Postoperative Bleeding And Perforation During Endoscopic Submucosal Dissection

Objective To evaluate the relevant risk factors of postoperative bleeding and perforation during endoscopic submucosal dissection(ESD)for esophageal mucosal or lesions.Methods From December 2013 to October 2016,the clinical,endoscopic and pathological data of patients with gastric mucosal lesions underwent endoscopic submucosal dissection in the Affiliated Hospital of Qiingdao University were recorded.Then collect information of patients who meet the requirement and analyze the following factors:1.Patient-related factors :gender,age,comorbidities like hypertension,diabetes mellitus and other chronic diseases,history of anticoagulants or anti-platelet agents.2.tumor-related factors:tumor diameter,location,quantity,Endoscopic classification,ulcer or scar findings,Helicobacter pylori(HP)infection and pathological type;3.procedure-related factors : operation time,operator experience,en-bloc resection and endoscopic clipping.SPSS19.0 statistical software was used to analyze the related factors by univariate and multivariate analysis,so as to determine the risk factors of perforation and postoperative bleeding in ESD.Results 1.Perforation during ESD occurred in 18 patients(18 lesions),the incidence rate was 3.6%.2.The predictors of intraoperative perforation are tumor location and tumor diameter.Multivariate analysis identified tumor location(upperstomach),tumor diameter(?2cm)as independent risk factors for perforation.The odds ratios were18.31(95% CI 4.31-78.04)for lesions in the upper stomach and 6.87(95% CI1.66-28.44)for lesions larger than 2cm.Therefore,lesions in the upperstomach and larger than 2cm were independent risk factors of intraoperative perforation.3.Univariate analysis identified gender,age,underlying disease,history of anticoagulants,Helicobacter pylori(HP)infection,ulcer or scar findings,pathological type,endoscopic classification and en-bloc resection are not predictors of perforation.4.Bleeding after ESD occurred in 12 patients(12 lesions),the incidence rate was2.4%.All patients with bleeding or perforation were cured by endoscopic treatment and no death occurred.5.Univariate analysis identified gender,age,underlying disease,history of anticoagulants,Helicobacter pylori(HP)infection,ulcer or scar findings,pathological type,endoscopic classification,tumor location and en-bloc resection are not predictors of postoperative bleeding.6.The predictors of postoperative bleeding is tumor diameter.Multivariate analysis identified tumor diameter(?4 cm)as independent risk factors for perforation.The odds ratios is 8.98(95% CI1.59-50.53)for lesions larger than 4 cm.Therefore lesions larger than 4cm is independent risk factors of postoperative bleeding.Conclusion 1.The predictors of intraoperative perforation are tumor located in upperstomach and diameter?2cm.2.The predictors of postoperative bleeding is tumor diameter ?4 cm.