Analysis Of Related Factors Of Complications After ESD In Treating Gastric Mucosal Lesions

Objective:To discuss the efficacy and the clinical risk factors associated with complications following Endoscopic submucosal dissection(ESD)of gastric mucosal lesions.Methods:Clinical,lesion-related and pathological data of 110 ESD patients with gastric mucosal lesions from Endoscopy Center between January 2013 and May 2017 were collected.The following factors associated with bleeding were analyzed patients-related factors(sex,age,history of smoking and(or)alcohol intake,concomitant diseases,history of administration or anticoagulants)? lesion-related factors(size,location and pathological types)? procedure-related factors(en-bloc resection,operation time and complication).To discuss the efficacy of ESD and determine the factors associated with complications following ESD of gastric mucosal lesions with univariate and multivariate analysis.Result:112(97.4%)of 115 lesions were resected successfully,108(93.9%)lesions were en-bloc resection,the complete resection rate was 100%.Acute bleeding occurred in 13 lesions(10 patients),the rate of acute bleeding was 11.6%;6 patients(5.4%)developed bleeding after ESD,among whom 4(66.7%)occurred within 24 hours,2(33.3%)within 1 week;Intraoperative perforation occurred in 4 patients(3.6%);No perforation after ESD or other complications were occurred.All complications were cured in medical or endoscopic therapy.Univariate and multivariate analysis revealed that lesion located at cardia-fundus of stomach(Odds ratio 4.071,95%CI 1.121-14.787)and early cancer(Odds ratio 8.973,95%CI 2.306-34.919)were independent risk factors for acute bleeding;Lesion located at antrum of stomach(Odds ratio 17.327,95%CI 1.615-185.864)and diameter of lesion?4cm(Odds ratio 12.734,95%CI 1.449-111.881)were independent risk factors for bleeding after ESD;Diameter of lesion?4cm was an independent risk factor for intraoperative perforation(Odds ratio 12.756,95%CI?1.162-139.998).Conclusion:ESD for gastric mucosal lesions is safe and feasible.Lesion located at cardia-fundus of stomach and early cancer were independent risk factors for acute bleeding;Lesion located at antrum of stomach and diameter of lesion?4cm were independent risk factors for bleeding after ESD;Diameter of lesion?4cm was an independent risk factor for intraoperative perforation.In view of the above,more attention is required during and after ESD to reduce the risk of complication.