Efficacy of endoscopic submucosal dissection for early gastric cancer and analysis in risk factors of intraoperative bleeding

Objective To analyze the efficacy of endoscopic submucosal dissection (ESD) for patients with early gastric cancer and the risk factors of intraoperative bleeding.

Methods A total of 156 patients diagnosed as early gastric cancer were randomly divided into ESD group (n=78) and total laparoscopic distal gastrectomy (TLDG) group (n=78). The postoperative efficacy and levels of serum tumor markerswere compared between the two groups; the univariate and multivariate Logistic regression analyses were used to analyze the influencing factors of intraoperative bleeding in patients with early gastric cancer.

Results The complete resection rate and en bloc resection rate of the lesion in the ESD group were significantly higher than those in the TLDG group, while the gastrointestinal function recovery time, hospital stay, postoperative fasting time, hospitalization costs and postoperative recovery time were significantly shorter or lower than those in the TLDG group (P<0.05). After operation, levels of carbohydrate antigen 199 (CA199) and carbohydrate antigen125 (CA125) in the ESD group were significantly lower than those in the TLDG group, while the level of pepsinogen Ⅰ (PG Ⅰ) was significantly higher than that in the TLDG group (P<0.05). According to the bleeding situation, the patients were divided into bleeding group (n=33) and non-bleeding group (n=123), and the ratios of patients with age≥60 years old, body mass index (BMI) ≥27 kg/m², accompanied by ulcer, and operation time>150 minutes in the bleeding group were significantly higher than those in the non-bleeding group (P<0.05). Multivariate Logistic regression analysis showed that age≥60 years old, BMI≥27 kg/m², operation time>150 minutes and accompanied by ulcer were the independent risk factors for intraoperative bleeding in patients with gastric cancer (P<0.05).

Conclusion ESD shows a good therapeutic effect in patients with early gastric cancer, which can effectively control levels of serum markers and reduce volume of intraoperative bleeding. Age≥ 60 years old, BMI≥27 kg/m², operation time>150 minutes and accompanied by ulcer are the independent risk factors for intraoperative bleeding in patients with gastric cancer.