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

• Tipo: Outra Publicação em Revista Científica Internacional
• Data: 2016

Autores

Libanio, D (Autor) FMUP; Costa, MN (Autor) Outra; Pedro Pimentel-Nunes (Autor) FMUP; Mario Dinis Ribeiro (Autor) FMUP

Revista

Título: Gastrointestinal Endoscopy

Vol. 84

Páginas: 572-586

ISSN: 0016-5107

Editora: Elsevier

Indexação

ISI Web of Knowledge - 94 Citações

Scopus - 105 Citações

Outras Informações

ID Authenticus: P-00M-A8F

DOI: 10.1016/j.gie.2016.06.033

Abstract (EN): Background 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.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 15