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Management of systolic blood pressure after endoscopic submucosal dissection is crucial for prevention of post-ESD gastric bleeding

Ebi, Masahidea; Shimura, Takayaa,b,c; Nishiwaki, Hirotakaa; Tanaka, Mamorua; Tsukamoto, Hironobua; Ozeki, Keijia; Sawada, Takeshia; Mizoshita, Tsutomua; Mori, Yoshinoria; Kubota, Eijia; Tanida, Satoshia; Kataoka, Hiromia; Joh, Takashia

European Journal of Gastroenterology & Hepatology: May 2014 - Volume 26 - Issue 5 - p 504–509
doi: 10.1097/MEG.0000000000000072
Original Articles: Gastro-oesophageal Disorders

Objective Endoscopic submucosal dissection (ESD) is a useful technique for early gastric neoplasms without lymph node metastasis. However, a critical complication is unpredictable post-ESD bleeding. Some risk factors for post-ESD bleeding have been reported previously, although those risk factors have not directly contributed toward prevention of post-ESD bleeding.

Materials and methods We retrospectively identified 186 gastric neoplasms in 183 consecutive patients treated with ESD from 2005 to 2012 at Nagoya City University Hospital, and divided them into two groups on the basis of the presence or absence of post-ESD bleeding.

Results Of the 186 lesions, eight lesions (4.2%) developed post-ESD bleeding. Univariate analysis identified hypertension (38.8% in nonbleeding vs. 87.5% in bleeding; P=0.009) and depressed-type tumors (26.4% in nonbleeding vs. 62.5% in bleeding; P=0.040) as significantly related to the incidence of post-ESD bleeding. On multivariate analysis, hypertension (odds ratio, 11.55; 95% confidence interval, 1.20–111.66; P=0.034) and depressed-type tumors (odds ratio, 5.36; 95% confidence interval, 1.12–25.73; P=0.036) were independent risk factors for post-ESD bleeding. Systolic blood pressure (SBP) after ESD was significantly higher in the post-ESD bleeding group than in the post-ESD non-bleeding group (P=0.021), with the comorbidity of hypertension significantly correlating with SBP after ESD (ρ=0.332, P<0.001).

Conclusion Control of SBP after ESD is important for the prevention of post-ESD bleeding because hypertension as a comorbidity, which is associated positively with SBP after ESD, is a significant risk factor for post-ESD bleeding.

aDepartment of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

bVascular Biology Program, Boston Children’s Hospital

cDepartment of Surgery, Harvard Medical School and Boston Children’s Hospital, Boston, USA

Correspondence to Takaya Shimura, MD, PhD, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan Tel: +81 52 853 8211; fax: +81 52 852 0952; e-mail:

Received December 18, 2013

Accepted January 31, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins