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Risk Factors for Bleeding After Gastric Endoscopic Submucosal Dissection: a Systematic Review and Meta-Analysis

2016-10Journal article Open access
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dc.contributor.authorLibânio, D
dc.contributor.authorNuno Costa, M
dc.contributor.authorPimentel-Nunes, P
dc.contributor.authorDinis-Ribeiro, M
dc.date.accessioned2017-06-09T11:38:23Z
dc.date.available2017-06-09T11:38:23Z
dc.date.issued2016-10
dc.description.abstractBACKGROUND AND AIMS: 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 I(2). 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationGastrointest Endosc. 2016 Oct;84(4):572-86pt_PT
dc.identifier.doi10.1016/j.gie.2016.06.033pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/2705
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.subjectCHLC GASpt_PT
dc.subjectAge Factorspt_PT
dc.subjectCarcinoma/pathologypt_PT
dc.subjectCarcinoma/surgery
dc.subjectEndoscopic Mucosal Resection
dc.subjectFibrinolytic Agents/therapeutic use
dc.subjectFibrosis
dc.subjectGastric Mucosa/surgery
dc.subjectGastrointestinal Hemorrhage/epidemiology
dc.subjectGastroscopy
dc.subjectHeart Diseases/epidemiology
dc.subjectHistamine H2 Antagonists/therapeutic use
dc.subjectHypertension/epidemiology
dc.subjectLiver Cirrhosis/epidemiology
dc.subjectNeoplasm Invasiveness
dc.subjectOdds Ratio
dc.subjectPostoperative Hemorrhage/epidemiology
dc.subjectProton Pump Inhibitors/therapeutic use
dc.subjectRenal Insufficiency, Chronic/epidemiology
dc.subjectRisk Factors
dc.subjectSecond-Look Surgery
dc.subjectSex Factors
dc.subjectStomach Diseases/epidemiology
dc.subjectStomach Neoplasms/pathology
dc.subjectStomach Neoplasms/surgery
dc.subjectStomach Ulcer/epidemiology
dc.subjectTumor Burden
dc.titleRisk Factors for Bleeding After Gastric Endoscopic Submucosal Dissection: a Systematic Review and Meta-Analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage586pt_PT
oaire.citation.issue4pt_PT
oaire.citation.startPage572pt_PT
oaire.citation.titleGastrointestinal Endoscopypt_PT
oaire.citation.volume84pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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