A Systematic Review and Meta-Analysis of Risk Factors for Delayed Bleeding After Endoscopic Submucosal Dissection in Early Gastric Cancer
ESD has become a standard of care for EGC due to its ability to provide curative resection with minimally invasive organ sparing approach, yet delayed bleeding poses considerable post-ESD risk factors for patient morbidity and health care consumption.Therefore, the systematic review and meta-analysis was conducted with the purpose of investigating the risk factors for late bleeding after ESD and the impact of each factor in EGC patients.A systematic review of these databases, PubMed, Embase, Web of Science, and the Cochrane Library was conducted till April 2025;Twelve imported and excluded prospective and retrospective studies which included 18 642 patients.Pooled odds ratios (ORs) with 95% CI were determined using a random effects model, and inter-study heterogeneity was evaluated using the I statistic.The meta-analysis further found that anticoagulant or antiplatelet administration (OR 2.94, 95% CI 2.21-3.89),large lesion size, 30 mm (OR 2.51, 95% CI 1.84-3.43),lesion ulceration (OR 1.68,, and CKD (Cr3 mg/dL) (OR 1.75, 95% CI 1.13-2.72)were significant predictors of delayed bleeding in patients with gastric cancer.There was moderate to low level of heterogeneity overall and no signs of significant publication bias.These observations underscore the necessity for proper risk
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