Rebleeding in patients with delayed bleeding after endoscopic submucosal dissection for early gastric cancer

Minami Hashimoto, Waku Hatta, Yosuke Tsuji, Toshiyuki Yoshio, Yohei Yabuuchi, Shu Hoteya, Hisashi Doyama, Yasuaki Nagami, Takuto Hikichi, Masakuni Kobayashi, Yoshinori Morita, Tetsuya Sumiyoshi, Mikitaka Iguchi, Hideomi Tomida, Takuya Inoue, Tatsuya Mikami, Kenkei Hasatani, Jun Nishikawa, Tomoaki Matsumura, Hiroko NebikiDai Nakamatsu, Ken Ohnita, Haruhisa Suzuki, Hiroya Ueyama, Yoshito Hayashi, Mitsushige Sugimoto, Mitsuhiro Fujishiro, Atsushi Masamune, Hiromasa Ohira

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Objectives: Delayed bleeding is a major adverse event in endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Some patients may experience rebleeding after successful hemostasis for delayed bleeding, yet the details of rebleeding remain unclear. We aimed to clarify the frequency and risk factors of rebleeding. Methods: Among 11,452 patients who underwent ESD for EGC at 33 institutions in Japan between 2013 and 2016, we analyzed 489 patients showing delayed bleeding. The rate of rebleeding was investigated. Subsequently, 15 candidate variables were evaluated for their influence on the risk of rebleeding via logistic regression analysis. Results: Rebleeding occurred in 11.2% (55/489) of the enrolled patients. Multivariate analysis revealed that warfarin [odds ratio (OR), 2.71; 95% confidence interval (CI), 1.26–5.84] and a resection size >40 mm (OR, 1.99; 95% CI, 1.08–3.67) were independent risk factors for rebleeding. In the analysis of the management of warfarin after index bleeding, only warfarin discontinuation (OR, 3.66; 95% CI, 1.37–9.78) was significantly associated with rebleeding in comparison with no use of warfarin. However, many rebleeding events (75.0%) occurred following the resumption of warfarin. The rebleeding rate during discontinuation status and that in taking warfarin (continuation or resumption) were 6.1% and 20.0%, respectively. Conclusions: Rebleeding was not a rare event in patients experiencing delayed bleeding after ESD for EGC. In addition to having a resection size >40 mm, warfarin usage placed patients at high risk for rebleeding, especially at the timing of its resumption following discontinuation as well as its continuation.

Original languageEnglish
Pages (from-to)1120-1130
Number of pages11
JournalDigestive Endoscopy
Issue number7
Publication statusPublished - 2021 Nov


  • delayed bleeding
  • early gastric cancers
  • endoscopic submucosal dissection
  • rebleeding
  • warfarin


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