Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study
Abstract Objectives In July 2017, supplementary guidelines on anticoagulants, including direct oral anticoagulants, were published in Japan. We investigated the changes in endoscopic submucosal dissection (ESD) of gastric mucosal lesions after the publication of the supplement, examined the risk fac...
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Wiley
2023-04-01
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| Online Access: | https://doi.org/10.1002/deo2.153 |
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| author | Keita Saito Hironobu Nagumo Takashi Ashikawa Tomoyuki Funato So Nakaji Hiroki Matsui |
| author_facet | Keita Saito Hironobu Nagumo Takashi Ashikawa Tomoyuki Funato So Nakaji Hiroki Matsui |
| author_sort | Keita Saito |
| collection | DOAJ |
| description | Abstract Objectives In July 2017, supplementary guidelines on anticoagulants, including direct oral anticoagulants, were published in Japan. We investigated the changes in endoscopic submucosal dissection (ESD) of gastric mucosal lesions after the publication of the supplement, examined the risk factors, and developed a predictive model for post‐ESD bleeding. Methods We included 2272 gastric ESD cases from our hospital between May 2003 and June 2021 and classified them into two groups: 1789 cases before and 483 after the publication of the supplementary guidelines. A predictive model for post‐ESD bleeding was developed using the pre‐publication cohort data. Results The proportion of patients receiving warfarin decreased (5.0% vs. 1.4%) and those receiving direct oral anticoagulants increased (1.2% vs. 6.8%) after the publication of the supplementary guidelines. Post‐ESD bleeding occurred in 61 patients, but there was no significant difference in the bleeding rate between the groups (50 [2.8%] vs. 11 [2.3%] patients, respectively). Five risk factors (number of antithrombotic agents, dialysis, heparin replacement, resection specimen size, and procedure time) were identified for model development. The C‐statistic for the model and post‐publication cohorts were 0.83 and 0.72, respectively. In the model, each risk factor for postoperative bleeding was scored, and the risk was classified into three levels according to the total score. Bleeding rates at low, intermediate, and high risks were 1.6%, 10.3%, and 38.9%, respectively. Conclusion Despite changes in patient characteristics and clinical practice regarding ESD before and after the publication of the supplementary guidelines, we could still develop a simple and useful predictive model. |
| format | Article |
| id | doaj-art-6af4cbb131ac4b009e2c699d973f5d33 |
| institution | Kabale University |
| issn | 2692-4609 |
| language | English |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | DEN Open |
| spelling | doaj-art-6af4cbb131ac4b009e2c699d973f5d332025-08-20T03:49:41ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.153Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective studyKeita Saito0Hironobu Nagumo1Takashi Ashikawa2Tomoyuki Funato3So Nakaji4Hiroki Matsui5Department of Gastroenterology Kameda General Hospital JapanDepartment of Gastroenterology Kameda General Hospital JapanDepartment of Gastroenterology Kameda General Hospital JapanDepartment of Gastroenterology Kameda General Hospital JapanDepartment of Gastroenterology Kameda General Hospital JapanDepartment of Public Health Medicine, Graduate School of Medicine University of Tokyo Tokyo JapanAbstract Objectives In July 2017, supplementary guidelines on anticoagulants, including direct oral anticoagulants, were published in Japan. We investigated the changes in endoscopic submucosal dissection (ESD) of gastric mucosal lesions after the publication of the supplement, examined the risk factors, and developed a predictive model for post‐ESD bleeding. Methods We included 2272 gastric ESD cases from our hospital between May 2003 and June 2021 and classified them into two groups: 1789 cases before and 483 after the publication of the supplementary guidelines. A predictive model for post‐ESD bleeding was developed using the pre‐publication cohort data. Results The proportion of patients receiving warfarin decreased (5.0% vs. 1.4%) and those receiving direct oral anticoagulants increased (1.2% vs. 6.8%) after the publication of the supplementary guidelines. Post‐ESD bleeding occurred in 61 patients, but there was no significant difference in the bleeding rate between the groups (50 [2.8%] vs. 11 [2.3%] patients, respectively). Five risk factors (number of antithrombotic agents, dialysis, heparin replacement, resection specimen size, and procedure time) were identified for model development. The C‐statistic for the model and post‐publication cohorts were 0.83 and 0.72, respectively. In the model, each risk factor for postoperative bleeding was scored, and the risk was classified into three levels according to the total score. Bleeding rates at low, intermediate, and high risks were 1.6%, 10.3%, and 38.9%, respectively. Conclusion Despite changes in patient characteristics and clinical practice regarding ESD before and after the publication of the supplementary guidelines, we could still develop a simple and useful predictive model.https://doi.org/10.1002/deo2.153anticoagulantsantithrombotic agentsbleedingendoscopic submucosal dissectionrisk factors |
| spellingShingle | Keita Saito Hironobu Nagumo Takashi Ashikawa Tomoyuki Funato So Nakaji Hiroki Matsui Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study DEN Open anticoagulants antithrombotic agents bleeding endoscopic submucosal dissection risk factors |
| title | Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study |
| title_full | Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study |
| title_fullStr | Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study |
| title_full_unstemmed | Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study |
| title_short | Predictive model for bleeding after gastric submucosal dissection before and after guidelines: A single‐center retrospective study |
| title_sort | predictive model for bleeding after gastric submucosal dissection before and after guidelines a single center retrospective study |
| topic | anticoagulants antithrombotic agents bleeding endoscopic submucosal dissection risk factors |
| url | https://doi.org/10.1002/deo2.153 |
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