Libânio, DNuno Costa, MPimentel-Nunes, PDinis-Ribeiro, M2017-06-092017-06-092016-10Gastrointest Endosc. 2016 Oct;84(4):572-86http://hdl.handle.net/10400.17/2705BACKGROUND 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.engCHLC GASAge FactorsCarcinoma/pathologyCarcinoma/surgeryEndoscopic Mucosal ResectionFibrinolytic Agents/therapeutic useFibrosisGastric Mucosa/surgeryGastrointestinal Hemorrhage/epidemiologyGastroscopyHeart Diseases/epidemiologyHistamine H2 Antagonists/therapeutic useHypertension/epidemiologyLiver Cirrhosis/epidemiologyNeoplasm InvasivenessOdds RatioPostoperative Hemorrhage/epidemiologyProton Pump Inhibitors/therapeutic useRenal Insufficiency, Chronic/epidemiologyRisk FactorsSecond-Look SurgerySex FactorsStomach Diseases/epidemiologyStomach Neoplasms/pathologyStomach Neoplasms/surgeryStomach Ulcer/epidemiologyTumor Burdenjournal article10.1016/j.gie.2016.06.033