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 23 February 2018

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News

Risks for postendoscopic mucosal resection hemorrhage

The latest European Journal of Gastroenterology & Hepatology identifies risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumors.

News image

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Endoscopic mucosal resection has been recognized as the standard treatment for gastric mucosal neoplasm.

However, postendoscopic mucosal resection hemorrhage remains a major complication of endoscopic mucosal resection.

This problem seems to be increasing owing to the development of invasive techniques.

Close monitoring is required with large lesions over 15 mm
European Journal of Gastroenterology & Hepatology

Dr Jae Woo Kim and colleagues determined the incidence and grade of postendoscopic mucosal resection hemorrhage.

The investigative team identified risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric neoplasm.

The team retrospectively analyzed data of endoscopic mucosal resections performed by 3 endoscopists, collected over 8 years.

Immediate postendoscopic mucosal resection hemorrhage was defined as bleeding during the procedure.

Delayed postendoscopic mucosal resection hemorrhage was defined when 2 of 4 parameters were satisfied after the endoscopic mucosal resection period.

The parameters included hematemesis, melena or dizziness, and hemoglobin loss over 2 g/dl.

The team assessed other parameters that included a blood pressure decrease over 20 mmHg or pulse rate increase over 20 per minute.

In addition, the investigators evaluated Forrest I or IIa and IIb on follow-up endoscopy.

The investigative reviewed a total of 157 patients, of which 113 were female with a mean age of 64 years.

The team found that 19% and 8% of patients presented with immediate and delayed postendoscopic mucosal resection hemorrhage, respectively.

On further analysis, the investigators showed that the patient's age, and the size of lesion predicted delayed postendoscopic mucosal resection hemorrhage.

The experience of the endoscopist was also a significantly predictive variable for the delayed postendoscopic mucosal resection hemorrhage.

Dr Kim' team concluded, “Considering the higher risk of delayed postendoscopic mucosal resection hemorrhage, careful preparation and close monitoring are required for patients who are under 65 years old.”

“In addition, close monitoring is require for patients with large lesions over 15 mm, or if the procedures were performed by an inexperienced endoscopist.”

Eur J Gastroenterol Hepatol 2007: 19(5): 409-15
11 April 2007

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