Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

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• 作者：Diogo Libâ ; nio ; MD¹ ; ; Mariana Nuno Costa ; MD² ; Pedro Pimentel-Nunes ; MD ; PhD¹ ; ³ ; Má ; rio Dinis-Ribeiro ; MD ; PhD¹ ; ³
• 关键词：AT ; antithrombotic therapy ; CI ; confidence interval ; ESD ; endoscopic submucosal dissection ; H2RA ; histamine-2 receptor antagonist ; OR ; odds ratio ; PPB ; postprocedural bleeding ; PPI ; proton pump inhibitor ; RCT ; randomized controlled trial ; SLE ; second-look endoscopy
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：84
• 期：4
• 页码：572-586
• 全文大小：1288 K

文摘

Postprocedural bleeding (PPB) is the most common adverse event associated with endoscopic resection. Several studies have tried to identify risk factors for PPB after gastric EMR and endoscopic submucosal dissection (ESD), with controversial results. This systematic review and meta-analysis aimed to identify significant risk factors for PPB after gastric EMR and ESD.

Methods

Three online databases were searched. Pooled odds ratio (OR) was computed for each risk factor using a random-effects model, and heterogeneity was assessed by Cochran’s Q test and I².

Results

Seventy-four articles were included. Pooled PPB rate was 5.1% (95% confidence interval, 4.5%-5.7%), which did not vary according to different study designs. Male sex (OR, 1.25), cardiopathy (OR, 1.54), antithrombotic drugs (OR, 1.63), cirrhosis (OR, 1.76), chronic kidney disease (OR, 3.38), tumor size > 20 mm (OR, 2.70), resected specimen size > 30 mm (OR, 2.85), localization in the lesser curvature (OR, 1.74), flat/depressed morphology (OR, 1.43), carcinoma histology (OR, 1.46), and ulceration (OR, 1.64) were identified as significant risk factors for PPB, whereas age, hypertension, submucosal invasion, fibrosis, and localization (upper, middle, or lower third) were not. Procedure duration > 60 minutes (OR, 2.05) and the use of histamine-2 receptor antagonists instead of proton pump inhibitors (OR, 2.13) were the procedural factors associated with PPB, whereas endoscopist experience and preprocedural proton pump inhibitors were not. Second-look endoscopy was not associated with decreased PPB (OR, 1.34; 95% confidence interval, .85-2.12).

Conclusions

Risk factors for PPB were identified that can help to guide management after gastric ESD, namely adjusting further management. Second-look endoscopy is not associated with decreased PPB.