Meta-analysis of predictive factors for delayed hemorrhage after endoscopic submucosal dissection in early-stage gastric carcinoma

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BACKGROUND Gastric cancer (GC) remains a substantial global health burden, and its early detection and treatment is critical for optimizing patient outcomes. Endoscopic submucosal dissection (ESD) is a minimally invasive technique for early GC but is linked to an increased risk of complications, such as delayed hemorrhage, which underscore the need for a comprehensive investigation into the disease’s risk factors. AIM To perform a comprehensive review and meta-analysis of the literature to identify and quantify risk factors associated with late-onset bleeding subsequent to ESD for early GC. METHODS Studies reporting risk factors for delayed bleeding after ESD for early GC were identified through a comprehensive search of electronic databases (PubMed, Embase, and Cochrane Library). The selection of studies, data retrieval, and quality evaluation were carried out separately by two reviewers. The combined odds ratios (OR) along with their 95% confidence intervals (CI) were calculated utilizing a random-effects approach. The meta-analysis has been registered on the International Registry of Systematic Review and Meta-analysis Protocols (INPLASY202540116). RESULTS A total of 11 publications comprising 1945 patients were incorporated into the present analysis. The following risk factors were found to be significantly associated with an increased risk of delayed bleeding after ESD: Long operation time (OR = 2.55, 95%CI: 2.40–2.72, I ² = 11%, n = 5 studies), lesions detected in the upper part of the stomach (OR = 3.44, 95%CI: 3.19-3.70, I ² = 0%, n = 4 studies), advanced age (OR = 3.61, 95%CI: 3.47-3.76, I ² = 38%, n = 5 studies), history of taking antithrombotic drugs (OR = 2.58, 95%CI: 2.48-2.68, I ² = 45%, n = 3 studies), resection size > 40 mm (OR = 3.01, 95%CI: 2.78-3.26, I ² = 31%, n = 5 studies), hemodialysis (OR = 2.42, 95%CI: 2.33-2.51, I ² = 0%, n = 4 studies), presence of ulcers (OR = 2.54, 95%CI: 2.33-2.77, I ² = 0%, n = 3 studies). CONCLUSION This meta-analysis identified several risk factors associated with an increased probability of delayed bleeding after ESD for early GC, including long operation time, lesions in the upper stomach, advanced age, antithrombotic drug use, large resection size, hemodialysis, and the presence of ulcers.

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