Table 2.
Ref. | Year | n | Study design | Bleeding (%) | Risk factors | Remarks |
Takizawa et al[5] | 2008 | 968 | Retrospective | 5.8% (7.1% vs 3.1% with PEC) | Tumor location in middle and lower regions of the stomach, PEC | PEC of visible vessels in the resected area follwing ESD may lead to a decreased bleeding rate |
Chung et al[30] | 2009 | 952 | Retrospective | 15.60% | Upper region, size of the tumor (> 40 mm), recurrent lesion, flat morphology | A significant bleeding incidence was at 0.6% |
Okada et al[10] | 2011 | 582 | Retrospective | 4.81% | Resected specimen width (≥ 40 mm) | Mechanism of delayed bleeding may differ depending on the time elapsed between ESD and bleeding episodes |
Toyokawa et al[11] | 2012 | 1123 | Retrospective | 5.00% | Age ≥ 80 yr, extended duration of procedure | - |
Goto et al[9] | 2012 | 1814 | Retrospective | 5.50% | No statistical parameters | Multicenter survey clarified that post-ESD management (duration of PPI use, resumption of food intake, and performance of SLE) varied among the medical centers |
Koh et al[12] | 2013 | 1032 | Retrospective | 5.30% | Size of resected specimen | The incidence of delayed bleeding in patients with two risk factors was 11.6% |
Choi et al[3] | 2014 | 614 | Prospective observation | Early (3.7%) Late (1.9%) | (> 40 mm), use of antithrombotic drugs (only for delay bleeding) Surface erosion, high risk of stigmata during SLE, location in the middle of the stomach | Nausea and submucosal fibrosis increase the incidence of high risk of stigmata in SLE |
PEC: Post-endoscopic submucosal dissection coagulation; ESD: Endoscopic submucosal dissection; PPI: Proton pump inhibitor; SLE: Second-look endoscopy.