Unraveling Factors Associated with Post-ESD Bleeding in Early Colorectal Cancer: A Retrospective Analysis of 446 Cases

Unraveling Factors Associated with Post-ESD Bleeding in Early Colorectal Cancer: A Retrospective Analysis of 446 Cases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unraveling Factors Associated with Post-ESD Bleeding in Early Colorectal Cancer: A Retrospective Analysis of 446 Cases Can SUN, Jie XING, Xinghua ZHANG, Peng LI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7966824/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To analyze the incidence and independent risk factors of postoperative bleeding in patients with early colorectal cancer (ECRC) after endoscopic submucosal dissection (ESD). Methods: We conducted a retrospective analysis of 446 ECRC patients who underwent ESD at our institution between January 2019 and December 2023. Patients were categorized into a bleeding group (n=27) and a non-bleeding group (n=419) based on the occurrence of postoperative bleeding. The bleeding rate was calculated, and multivariate logistic regression was employed to identify independent risk factors. Results: Post-ESD bleeding occurred in 27 of the 446 patients, yielding a bleeding rate of 6.05%. Multivariate logistic regression analysis identified hypertension (OR=1.952), lesion size ≥30mm (OR=2.210), and operation time ≥40 minutes (OR=2.022) as independent risk factors for postoperative bleeding (all P<0.05). Conclusion: The incidence of bleeding after ESD for early colorectal cancer was 6.05%. Independent risk factors included hypertension, large lesions (≥30mm), and prolonged operation time (≥40 min). Targeted interventions for patients with these characteristics may help reduce the risk of post-ESD bleeding. Early colorectal cancer Bleeding Endoscopic submucosal dissection Introduction With improvements in living standards and the disruptions in daily routines, the prevalence of gastrointestinal tumors has increased annually, posing a serious threat to patient safety. The development and widespread clinical application of high-definition endoscopy and magnifying endoscopy have substantially improved the detection rate of early gastrointestinal cancers, thereby greatly enhancing the survival rate of patients with gastrointestinal cancers[ 1 ]. Compared to traditional surgical procedures, Endoscopic Submucosal Dissection (ESD) offers advantages such as minimal invasiveness, lower cost, faster recovery, and fewer complications. However, intraoperative factors like lesion location and size can increase the risk of postoperative bleeding [ 2 , 3 ]. Currently, the influencing factors related to postoperative bleeding in patients with early gastrointestinal cancer after ESD are not fully understood. Therefore, this study analyzed the occurrence of bleeding in patients with early colorectal cancer after ESD and investigated its related factors, aiming to provide references and basis for clinically reducing the risk of post-ESD bleeding. 1 Data and Methods 1.1 General Data Clinical data were retrospectively collected from 446 patients with early colorectal cancer who underwent ESD at our hospital between January 2019 and December 2023. Postoperative bleeding was defined as: ① bleeding requiring endoscopic hemostasis, ② a postoperative hemoglobin drop of > 2 g/dL compared to preoperative levels; or③ massive hematochezia after ESD without other obvious sources of bleeding. Based on the occurrence of postoperative bleeding, patients were divided into a bleeding group (27 cases) and a non-bleeding group (419 cases). The general characteristics of the two groups are shown in Table 1 . This study was conducted in accordance with the Declaration of Helsinki and was approved by the Beijing Friendship Hospital Ethics Committee. Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for informed consent was waived by the Beijing Friendship Hospital Ethics Committee. 1.2 Inclusion and Exclusion Criteria Inclusion criteria: ① Meeting the diagnostic criteria for early colorectal cancer according to Chinese protocol of diagnosis and treatment of colorectal cancer ( 2020 edition ) and subsequent ESD treatment; ② Absence of severe cardiovascular and cerebrovascular diseases, hepatic, renal, or hematopoietic system diseases; ③ Complete clinical data. Exclusion criteria: ① Patients with mid-to-late stage colorectal malignant tumors; ② Patients combined with other malignant tumors; ③ Patients with contraindications to ESD; ④ Pregnant or lactating women. 1.3 Methods and Observation Indicators 1.3.1 Univariate Analysis Based on the clinical data, general information such as gender, age, history of hypertension, diabetes, coronary heart disease, macroscopic tumor type, depth of invasion, tumor location, lesion diameter, operation time, medical history of aspirin, metformin, and clopidogrel were compared between the two groups. 1.3.2 Risk Factor Analysis Multivariate Logistic regression analysis was used to identify the risk factors for post-ESD bleeding in ECRC patients. 1.4 Statistical Methods Data were statistically analyzed using SPSS 21.0. Measurement data were tested for normality using the Kolmogorov-Smirnov test. Normally distributed measurement data were expressed as mean ± standard deviation (x̄ ± s) and compared using independent samples t-test between groups; non-normally distributed measurement data were expressed as median (interquartile range) [M (P25, P75)] and compared using the independent samples Mann-Whitney test between groups. Count data were expressed as the number and percentage (%) of positive cases, and compared using the chi-square test between groups. Multi-index comparisons were performed using the χ² trend test. Risk factors for bleeding in patients with early gastrointestinal cancer after ESD were analyzed using multivariate logistic regression analysis. 2 Results 2.1 Baseline Characteristics of Patients with Post-ESD Bleeding Among 446 patients with early colorectal cancer who underwent ESD, 27 patients experienced postoperative bleeding, resulting in a bleeding rate of 6.05%. No significant differences were observed between the two groups in terms of gender distribution, age, or the proportions of patients with diabetes or coronary heart disease. However, the proportion of patients with hypertension was significantly higher in the bleeding group than in the non-bleeding group (62.96% vs. 30.55%, P < 0.05). There were no significant differences in tumor location, macroscopic type, or depth of invasion between the two groups. The lesion diameter in the bleeding group was larger than that in the non-bleeding group, and the operation time was longer than that in the non-bleeding group, with significant differences (p < 0.05). No significant differences were found in the medical history of aspirin, clopidogrel, or metformin use between the groups (Table 1 ). Table 1 Baseline Characteristics of Patients with Early Colorectal Cancer Experiencing Bleeding After ESD Bleeding Group( n = 27) Non-Bleeding Group( n = 419) χ 2 P Gender[ n (%)] 0.508 0.476 male 12(44.44) 237(56.56) female 15(55.56) 182(43.44) Age (years, x̄ ± s) 65.36 ± 9.10 64.11 ± 10.37 0.760 0.383 Hypertension[ n (%)] 17(62.96) 128(30.55) 4.490 0.034 Diabetes[ n (%)] 5(18.52) 79(18.85) 0.656 0.418 Coronary Heart Disease[ n (%)] 7(16.33) 52(12.41) 2.000 0.165 Macroscopic Type[ n (%)] 1.146 0.564 Non-LST 10(37.04) 222(52.98) LST-G 12(44.44) 138(32.94) LST-NG 5(18.52) 59(14.08) Depth of Invasion [n(%)] 0.108 0.947 M 22(81.48) 330(78.76) SM1 3(11.11) 39(9.31) SM2 2(7.41) 50(11.93) Lesion Diameter(mm) 19.0(13.5, 29.5) 33.0(22.0, 37.0) 11.916 0.001 Operation Time(min) 44.0(25.5, 74.0) 55.0(40.0, 104.0) 4.604 0.032 Location[ n (%)] 2.701 0.259 Right Colon 5(18.52) 108(25.78) Left Colon 6(22.22) 148(35.32) Rectum 16(59.26) 163(38.90) medical history Aspirin[ n (%)] 3(24.49) 47(26.97) 0.046 0.831 Metformin[ n (%)] 3(28.57) 37(29.09) 0.001 0.976 Clopidogrel[ n (%)] 2(34.69) 11(20.22) 2.126 0.145 2.2 Univariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer Univariate analysis revealed that hypertension, lesion diameter ≥ 30 mm, and operation time ≥ 40 minutes were significantly associated with the occurrence of post-ESD bleeding ( P < 0.05) (Table 2 ). Table 2 Univariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer β SE Wald/χ 2 P OR 95%CI gender -0.820 0.646 1.613 0.204 0.440 0.124ཞ1.561 age > 60 years 0.685 0.799 0.734 0.392 1.983 0.414ཞ9.499 Hypertension 1.297 0.648 4.009 0.045 3.659 1.028 ~ 13.027 Coronary Heart Disease 0.979 0.716 1.868 0.172 2.661 0.654ཞ10.826 Diabetes -0.841 1.067 0.621 0.431 0.431 0.053ཞ3.491 LST Type Lesion 0.677 0.645 1.102 0.294 1.969 0.556ཞ6.974 Lesion Located in Rectum -1.014 0.646 2.464 0.117 0.363 0.102ཞ1.287 Lesion Diameter ≥ 30mm 2.095 0.700 8.960 0.003 8.127 2.061 ~ 32.044 Operation Time ≥ 40min 1.970 1.060 3.453 0.063 7.172 0.898 ~ 57.297 Aspirin -0.023 1.077 0.046 0.831 0.795 0.096ཞ6.557 Metformin 0.033 1.083 0.001 0.976 1.033 0.124ཞ8.633 Clopidogrel 1.167 0.842 1.923 0.166 3.212 0.617ཞ16.718 2.3 Multivariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer Multivariate logistic regression analysis confirmed that hypertension (OR = 1.952, 95% CI: 1.074–3.549), lesion diameter ≥ 30mm (OR = 2.210, 95% CI: 1.204–4.058), and operation time ≥ 40 minutes (OR = 2.022, 95% CI: 1.061–3.853) were independent risk factors for post-ESD bleeding in ECRC patients (all P < 0.05) (Table 3 ). Table 3 Multivariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer β SE Wald/χ 2 P OR 95%CI Hypertension 0.669 0.305 4.811 0.028 1.952 1.074 ~ 3.549 Lesion Diameter ≥ 30mm 0.793 0.310 6.544 0.011 2.210 1.204 ~ 4.058 Operation Time ≥ 40min 0.704 0.329 4.579 0.032 2.022 1.061 ~ 3.853 3 Discussion Gastrointestinal cancer encompasses gastric, duodenal, colon, and esophageal cancers. Gastrointestinal early cancer and precancerous lesions are mainly located in the mucosal layer. The development of endoscopic therapy represents a milestone in the management of early gastrointestinal cancers and precancerous diseases, paving a new, minimally invasive pathway for patients.Endoscopic Submucosal Dissection (ESD) is an advanced minimally invasive technique developed from Endoscopic Mucosal Resection (EMR). Its en bloc resection rate is significantly superior to traditional EMR techniques (89% vs. 43%)[ 4 ]. Through precise submucosal dissection, ESD enables the complete removal of flat and broad-based polyps ranging from 20–50 mm in size [ 5 ]. With ongoing refinements in instruments and procedural standardization, ESD has been widely adopted for treating early colorectal cancer and precancerous lesions. However, multicenter data indicate that it still carries specific risks of complications [ 6 ]. Bleeding is a common complication following ESD for early gastrointestinal cancer, with reported incidence rates ranging from 2.4% to 12% in colorectal ESD [ 7 ]. Clinical manifestations include melena, hematochezia, hematemesis, and potentially hemorrhagic shock, often necessitating emergency endoscopic intervention. Severe cases may require blood transfusion or surgery. Our study showed a bleeding rate of 6.05% among the 446 patients with early colorectal cancer after ESD, indicating a relatively high incidence. Therefore, analyzing the risk factors for bleeding in these patients is of great significance for reducing the risk of bleeding. The results of our study identified that hypertension, lesion diameter ≥ 30mm, and operation time ≥ 40min as independent risk factors for bleeding in patients with early gastrointestinal cancer after ESD.The underlying reasons are considered as follows: ESD is a technically demanding endoscopic procedure. The wall of the colon and rectum is thinner than that of the esophagus and stomach, complicating intraoperative manipulation.Furthermore, the vascular distribution is denser, resulting in a higher inherent risk of bleeding after ESD for early colorectal cancer. In hypertensive patients, long-term elevated blood pressure leads to increased vascular fragility and permeability, intimal edema, and degenerative changes in the vessel wall [ 8 , 9 ].This structural compromise predisposes to bleeding. Additionally, postoperative blood pressure is often elevated compared to preoperative levels, and patients may even experience hypertensive crises. The weakened ability of compromised vessels to tolerate blood pressure fluctuations further increases the risk of postoperative bleeding [ 10 , 11 ]. Therefore, for hypertensive patients, strict preoperative blood pressure control is essential, and ESD should be scheduled only when blood pressure is stable within the normal range. Meticulous intraoperative hemostasis is crucial, utilizing titanium clips or topical hemostatic agents as needed. Simultaneously, postoperative blood pressure fluctuations should be closely monitored to reduce the risk of bleeding. Hypertension is a recognized risk factor for post-ESD bleeding, and its co-existence with anticoagulant therapy creates a high-risk scenario[ 11 ]. A comprehensive management strategy, including strict preoperative anticoagulant management and risk assessment using tools like the Limoges Bleeding Score (LBS), is recommended for these patients to facilitate personalized perioperative care and mitigate bleeding risk [ 10 , 11 ]. Studies have shown that lesion size and complexity (including border distinctness, morphological characteristics, surface structure, and submucosal fibrosis) are important predictive indicators for post-ESD bleeding[ 6 , 12 , 13 ]. Larger colorectal lesions involve a richer vascular network, increasing the difficulty of both resection and effective electrocoagulation hemostasis, thereby elevating the risk of post-ESD bleeding [ 13 , 14 ]. Therefore, for patients with lesion diameters ≥ 30mm, while ensuring complete resection, efforts should be made to minimize the wound area. After resection, carefully managing exposed vessels in the wound base is essential to reduce bleeding risk. Operation time reflects procedural complexity. Longer operation times are associated with an increased incidence of postoperative complications, including bleeding and perforation [ 15 , 16 ]. Numerous factors affect operation time, including lesion location, size, depth of invasion.Prolonged operation time may reduce blood flow in the wound are, predisposing to ulcer formation and increasing the risk of postoperative bleeding [ 17 , 18 ]. Optimization of intraoperative hemostatic techniques is vital for preventing early postoperative bleeding. The application of novel hemostatic materials, such as polysaccharide hemostatic powder (PHP), for wound management is recommended[ 19 ]. Compared to the traditional forced coagulation mode (FCM-ESD), the spray coagulation mode (SCM-ESD) demonstrates superior hemostatic efficacy, effectively reducing intraoperative blood loss[ 20 ]. Furthermore, techniques like double-clip traction combined with a rubber band (DCT-ESD) significantly improve endoscopic field exposure, lower procedural difficulty, minimize iatrogenic injury, and consequently reduce bleeding risk[ 21 ].Therefore, thorough preoperative assessment, appropriate planning for multiple lesions, and efficient scheduling of operation time are essential. In summary, this study confirmed an overall post-ESD bleeding rate of 6.05% in patients with early colonretal cancer. Hypertension, lesion diameter ≥ 30mm, and operation time ≥ 40 minutes were identified as independent risk factors. Consequently, risk stratification and targeted interventions should be implemented for patients with these characteristics to mitigate post-ESD bleeding risk. Given the single-center, retrospective design and limited sample size of this study, larger-scale, preferably prospective, research is warranted to confirm these findings. Declarations Funding : This study was supported by National Key Research and Development Program of China (Grant No. 2023YFC2507400). Competing interests : The authors declare no competing interests. Ethics approval and consent to participate : Retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Beijing Friendship Hospital Ethics Committee. Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for informed consent was waived by the Beijing Friendship Hospital Ethics Committee. Consent for publication: Not applicable. Date Availability: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Authors' contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Can Sun and Jie Xing. The first draft of the manuscript was written by Can Sun and all authors (Jie Xing, Xinghua Zhang and Peng Li ) commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Probst A, Ebigbo A, Messmann H. Endoscopic techniques for early stage cancer of the upper and lower gastrointestinal tract: possibilities and limitations. Chirurg. 2018;89:365–73. https://doi.org/10.1007/s00104-017-0567-0 . Yamamura T, Nakamura M, Hiramatsu Metal. Effectiveness of self-assembling peptide in reducing bleeding after colorectal endoscopic submucosal dissection. Gastrointest Endosc. 2025. https://doi.org/10.1016/j.gie.2025.08.042 . Bordillon P, Pioche M, Wallenhorst Tetal. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc. 2021;94:333–43. https://doi.org/10.1016/j.gie.2021.01.036 . Mejia Perez LK, Yang D, Draganov PVetal. 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Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan. Intern Med. 2018;57:2115–22. https://doi.org/10.2169/internalmedicine.0446-17 . Yoshida N, Hirose R, Dohi Oetal. A novel reopenable clip with sharp claw for complete closure of mucosal defects after colorectal endoscopic submucosal dissection. Endoscopy. 2025;57:354–60. https://doi.org/10.1055/a-2421-9767 . Sakamoto T, Saito Y, Nakamura Fetal. Short-term outcomes following endoscopic submucosal dissection of large protruding colorectal neoplasms. Endoscopy. 2018;50:606–12. https://doi.org/10.1055/s-0043-123578 . Ozeki Y, Hirasawa K, Ikeda Retal. Safety and efficacy of water pressure endoscopic submucosal dissection for colorectal tumors with submucosal fibrosis (with video). Gastrointest Endosc. 2021;94:607–e6172. https://doi.org/10.1016/j.gie.2021.03.026 . Jung DH, Moon HS, Park CH, Park JC. Polysaccharide hemostatic powder to prevent bleeding after endoscopic submucosal dissection in high risk patients: a randomized controlled trial. Endoscopy. 2021;53:994–1002. https://doi.org/10.1055/a-1312-9420 . Esaki M, Sumida Y, Maehara Ketal. Spray and Forced Coagulation Mode Endoscopic Submucosal Dissection for Early Gastric Neoplasms: A Multicenter Randomized Controlled Trial. Am J Gastroenterol. 2025. https://doi.org/10.14309/ajg.0000000000003360 . Bordillon P, Pioche M, Wallenhorst Tetal. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc. 2021;94:333–43. https://doi.org/10.1016/j.gie.2021.01.036 . Additional Declarations No competing interests reported. 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The development and widespread clinical application of high-definition endoscopy and magnifying endoscopy have substantially improved the detection rate of early gastrointestinal cancers, thereby greatly enhancing the survival rate of patients with gastrointestinal cancers[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Compared to traditional surgical procedures, Endoscopic Submucosal Dissection (ESD) offers advantages such as minimal invasiveness, lower cost, faster recovery, and fewer complications. However, intraoperative factors like lesion location and size can increase the risk of postoperative bleeding [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Currently, the influencing factors related to postoperative bleeding in patients \u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003ewith early gastrointestinal cancer after ESD are not fully understood. Therefore, this study analyzed the occurrence of bleeding in patients with early colorectal cancer after ESD and investigated its related factors, aiming to provide references and basis for clinically reducing the risk of post-ESD bleeding.\u003c/p\u003e"},{"header":"1 Data and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1 General Data\u003c/h2\u003e\u003cp\u003eClinical data were retrospectively collected from 446 patients with early colorectal cancer who underwent ESD at our hospital between January 2019 and December 2023. Postoperative bleeding was defined as: ① bleeding requiring endoscopic hemostasis, ② a postoperative hemoglobin drop of \u0026gt;\u0026thinsp;2 g/dL compared to preoperative levels; or③ massive hematochezia after ESD without other obvious sources of bleeding. Based on the occurrence of postoperative bleeding, patients were divided into a bleeding group (27 cases) and a non-bleeding group (419 cases). The general characteristics of the two groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. This study was conducted in accordance with the Declaration of Helsinki and was approved by the Beijing Friendship Hospital Ethics Committee. Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for informed consent was waived by the Beijing Friendship Hospital Ethics Committee.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Inclusion and Exclusion Criteria\u003c/h2\u003e\u003cp\u003eInclusion criteria: ① Meeting the diagnostic criteria for early colorectal cancer according to \u003cem\u003eChinese protocol of diagnosis and treatment of colorectal cancer\u003c/em\u003e(\u003cem\u003e2020 edition\u003c/em\u003e) and subsequent ESD treatment; ② Absence of severe cardiovascular and cerebrovascular diseases, hepatic, renal, or hematopoietic system diseases; ③ Complete clinical data. Exclusion criteria: ① Patients with mid-to-late stage colorectal malignant tumors; ② Patients combined with other malignant tumors; ③ Patients with contraindications to ESD; ④ Pregnant or lactating women.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Methods and Observation Indicators\u003c/h2\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e1.3.1 Univariate Analysis\u003c/h2\u003e\u003cp\u003eBased on the clinical data, general information such as gender, age, history of hypertension, diabetes, coronary heart disease, macroscopic tumor type, depth of invasion, tumor location, lesion diameter, operation time, medical history of aspirin, metformin, and clopidogrel were compared between the two groups.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e1.3.2 Risk Factor Analysis\u003c/h2\u003e\u003cp\u003eMultivariate Logistic regression analysis was used to identify the risk factors for post-ESD bleeding in ECRC patients.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e1.4 Statistical Methods\u003c/h2\u003e\u003cp\u003eData were statistically analyzed using SPSS 21.0. Measurement data were tested for normality using the Kolmogorov-Smirnov test. Normally distributed measurement data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; s) and compared using independent samples t-test between groups; non-normally distributed measurement data were expressed as median (interquartile range) [M (P25, P75)] and compared using the independent samples Mann-Whitney test between groups. Count data were expressed as the number and percentage (%) of positive cases, and compared using the chi-square test between groups. Multi-index comparisons were performed using the χ\u0026sup2; trend test. Risk factors for bleeding in patients with early gastrointestinal cancer after ESD were analyzed using multivariate logistic regression analysis.\u003c/p\u003e\u003c/div\u003e"},{"header":"2 Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Baseline Characteristics of Patients with Post-ESD Bleeding\u003c/h2\u003e\u003cp\u003eAmong 446 patients with early colorectal cancer who underwent ESD, 27 patients experienced postoperative bleeding, resulting in a bleeding rate of 6.05%. No significant differences were observed between the two groups in terms of gender distribution, age, or the proportions of patients with diabetes or coronary heart disease. However, the proportion of patients with hypertension was significantly higher in the bleeding group than in the non-bleeding group (62.96% vs. 30.55%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There were no significant differences in tumor location, macroscopic type, or depth of invasion between the two groups. The lesion diameter in the bleeding group was larger than that in the non-bleeding group, and the operation time was longer than that in the non-bleeding group, with significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were found in the medical history of aspirin, clopidogrel, or metformin use between the groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics of Patients with Early Colorectal Cancer Experiencing Bleeding After ESD\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBleeding Group(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-Bleeding Group(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;419)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(44.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e237(56.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15(55.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182(43.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years, x̄ \u0026plusmn; s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65.36\u0026thinsp;\u0026plusmn;\u0026thinsp;9.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.11\u0026thinsp;\u0026plusmn;\u0026thinsp;10.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.760\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.383\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(62.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e128(30.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.490\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(18.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79(18.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.656\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.418\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary Heart Disease[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7(16.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52(12.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.165\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMacroscopic Type[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.564\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-LST\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10(37.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e222(52.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLST-G\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(44.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e138(32.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLST-NG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(18.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59(14.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDepth of Invasion [n(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.947\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22(81.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e330(78.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(11.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39(9.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSM2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(7.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50(11.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion Diameter(mm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19.0(13.5, 29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.0(22.0, 37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.916\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperation Time(min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44.0(25.5, 74.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.0(40.0, 104.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.604\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLocation[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.701\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.259\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight Colon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(18.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108(25.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft Colon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6(22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e148(35.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRectum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16(59.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e163(38.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emedical history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAspirin[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(24.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47(26.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3(28.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37(29.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.976\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClopidogrel[\u003cem\u003en\u003c/em\u003e(%)]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(34.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11(20.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Univariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer\u003c/h2\u003e\u003cp\u003eUnivariate analysis revealed that hypertension, lesion diameter\u0026thinsp;\u0026ge;\u0026thinsp;30 mm, and operation time\u0026thinsp;\u0026ge;\u0026thinsp;40 minutes were significantly associated with the occurrence of post-ESD bleeding (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWald/χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.820\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.646\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.613\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.124ཞ1.561\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u0026thinsp;\u0026gt;\u0026thinsp;60 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.799\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.734\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.983\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.414ཞ9.499\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.648\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.659\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.028\u0026thinsp;~\u0026thinsp;13.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary Heart Disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.979\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.868\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.654ཞ10.826\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.841\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.621\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.053ཞ3.491\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLST Type Lesion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.645\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.969\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.556ཞ6.974\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion Located in Rectum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.646\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.102ཞ1.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion Diameter\u0026thinsp;\u0026ge;\u0026thinsp;30mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.700\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.960\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.061\u0026thinsp;~\u0026thinsp;32.044\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperation Time\u0026thinsp;\u0026ge;\u0026thinsp;40min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.970\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.898\u0026thinsp;~\u0026thinsp;57.297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAspirin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.831\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.096ཞ6.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetformin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.976\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.124ཞ8.633\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClopidogrel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.842\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.617ཞ16.718\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Multivariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer\u003c/h2\u003e\u003cp\u003eMultivariate logistic regression analysis confirmed that hypertension (OR\u0026thinsp;=\u0026thinsp;1.952, 95% CI: 1.074\u0026ndash;3.549), lesion diameter\u0026thinsp;\u0026ge;\u0026thinsp;30mm (OR\u0026thinsp;=\u0026thinsp;2.210, 95% CI: 1.204\u0026ndash;4.058), and operation time\u0026thinsp;\u0026ge;\u0026thinsp;40 minutes (OR\u0026thinsp;=\u0026thinsp;2.022, 95% CI: 1.061\u0026ndash;3.853) were independent risk factors for post-ESD bleeding in ECRC patients (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate Logistic Regression Analysis of Post-ESD Bleeding in Patients with Early Colorectal Cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWald/χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95%CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.669\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.952\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.074\u0026thinsp;~\u0026thinsp;3.549\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLesion Diameter\u0026thinsp;\u0026ge;\u0026thinsp;30mm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.793\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.310\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.544\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.204\u0026thinsp;~\u0026thinsp;4.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperation Time\u0026thinsp;\u0026ge;\u0026thinsp;40min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.704\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.579\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.061\u0026thinsp;~\u0026thinsp;3.853\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Discussion","content":"\u003cp\u003eGastrointestinal cancer encompasses gastric, duodenal, colon, and esophageal cancers. Gastrointestinal early cancer and precancerous lesions are mainly located in the mucosal layer. The development of endoscopic therapy represents a milestone in the management of early gastrointestinal cancers and precancerous diseases, paving a new, minimally invasive pathway for patients.Endoscopic Submucosal Dissection (ESD) is an advanced minimally invasive technique developed from Endoscopic Mucosal Resection (EMR). Its en bloc resection rate is significantly superior to traditional EMR techniques (89% vs. 43%)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Through precise submucosal dissection, ESD enables the complete removal of flat and broad-based polyps ranging from 20\u0026ndash;50 mm in size [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. With ongoing refinements in instruments and procedural standardization, ESD has been widely adopted for treating early colorectal cancer and precancerous lesions. However, multicenter data indicate that it still carries specific risks of complications [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBleeding is a common complication following ESD for early gastrointestinal cancer, with reported incidence rates ranging from 2.4% to 12% in colorectal ESD [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Clinical manifestations include melena, hematochezia, hematemesis, and potentially hemorrhagic shock, often necessitating emergency endoscopic intervention. Severe cases may require blood transfusion or surgery. Our study showed a bleeding rate of 6.05% among the 446 patients with early colorectal cancer after ESD, indicating a relatively high incidence. Therefore, analyzing the risk factors for bleeding in these patients is of great significance for reducing the risk of bleeding.\u003c/p\u003e\u003cp\u003eThe results of our study identified that hypertension, lesion diameter\u0026thinsp;\u0026ge;\u0026thinsp;30mm, and operation time\u0026thinsp;\u0026ge;\u0026thinsp;40min as independent risk factors for bleeding in patients with early gastrointestinal cancer after ESD.The underlying reasons are considered as follows: ESD is a technically demanding endoscopic procedure. The wall of the colon and rectum is thinner than that of the esophagus and stomach, complicating intraoperative manipulation.Furthermore, the vascular distribution is denser, resulting in a higher inherent risk of bleeding after ESD for early colorectal cancer. In hypertensive patients, long-term elevated blood pressure leads to increased vascular fragility and permeability, intimal edema, and degenerative changes in the vessel wall [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].This structural compromise predisposes to bleeding. Additionally, postoperative blood pressure is often elevated compared to preoperative levels, and patients may even experience hypertensive crises. The weakened ability of compromised vessels to tolerate blood pressure fluctuations further increases the risk of postoperative bleeding [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, for hypertensive patients, strict preoperative blood pressure control is essential, and ESD should be scheduled only when blood pressure is stable within the normal range. Meticulous intraoperative hemostasis is crucial, utilizing titanium clips or topical hemostatic agents as needed. Simultaneously, postoperative blood pressure fluctuations should be closely monitored to reduce the risk of bleeding. Hypertension is a recognized risk factor for post-ESD bleeding, and its co-existence with anticoagulant therapy creates a high-risk scenario[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A comprehensive management strategy, including strict preoperative anticoagulant management and risk assessment using tools like the Limoges Bleeding Score (LBS), is recommended for these patients to facilitate personalized perioperative care and mitigate bleeding risk [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudies have shown that lesion size and complexity (including border distinctness, morphological characteristics, surface structure, and submucosal fibrosis) are important predictive indicators for post-ESD bleeding[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Larger colorectal lesions involve a richer vascular network, increasing the difficulty of both resection and effective electrocoagulation hemostasis, thereby elevating the risk of post-ESD bleeding [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, for patients with lesion diameters\u0026thinsp;\u0026ge;\u0026thinsp;30mm, while ensuring complete resection, efforts should be made to minimize the wound area. After resection, carefully managing exposed vessels in the wound base is essential to reduce bleeding risk. Operation time reflects procedural complexity. Longer operation times are associated with an increased incidence of postoperative complications, including bleeding and perforation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Numerous factors affect operation time, including lesion location, size, depth of invasion.Prolonged operation time may reduce blood flow in the wound are, predisposing to ulcer formation and increasing the risk of postoperative bleeding [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Optimization of intraoperative hemostatic techniques is vital for preventing early postoperative bleeding. The application of novel hemostatic materials, such as polysaccharide hemostatic powder (PHP), for wound management is recommended[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Compared to the traditional forced coagulation mode (FCM-ESD), the spray coagulation mode (SCM-ESD) demonstrates superior hemostatic efficacy, effectively reducing intraoperative blood loss[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, techniques like double-clip traction combined with a rubber band (DCT-ESD) significantly improve endoscopic field exposure, lower procedural difficulty, minimize iatrogenic injury, and consequently reduce bleeding risk[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].Therefore, thorough preoperative assessment, appropriate planning for multiple lesions, and efficient scheduling of operation time are essential.\u003c/p\u003e\u003cp\u003eIn summary, this study confirmed an overall post-ESD bleeding rate of 6.05% in patients with early colonretal cancer. Hypertension, lesion diameter\u0026thinsp;\u0026ge;\u0026thinsp;30mm, and operation time\u0026thinsp;\u0026ge;\u0026thinsp;40 minutes were identified as independent risk factors. Consequently, risk stratification and targeted interventions should be implemented for patients with these characteristics to mitigate post-ESD bleeding risk. Given the single-center, retrospective design and limited sample size of this study, larger-scale, preferably prospective, research is warranted to confirm these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis study was supported by National Key Research and Development Program of China\u0026nbsp;(Grant No. 2023YFC2507400).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eRetrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Beijing Friendship Hospital Ethics Committee. Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for informed consent was waived by the Beijing Friendship Hospital Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDate\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAvailability:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Can Sun and Jie Xing. The first draft of the manuscript was written by Can Sun \u0026nbsp;and all authors (Jie Xing, Xinghua Zhang \u0026nbsp;and Peng Li ) commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eProbst A, Ebigbo A, Messmann H. Endoscopic techniques for early stage cancer of the upper and lower gastrointestinal tract: possibilities and limitations. Chirurg. 2018;89:365\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00104-017-0567-0\u003c/span\u003e\u003cspan address=\"10.1007/s00104-017-0567-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamamura T, Nakamura M, Hiramatsu Metal. Effectiveness of self-assembling peptide in reducing bleeding after colorectal endoscopic submucosal dissection. 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Spray and Forced Coagulation Mode Endoscopic Submucosal Dissection for Early Gastric Neoplasms: A Multicenter Randomized Controlled Trial. Am J Gastroenterol. 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.14309/ajg.0000000000003360\u003c/span\u003e\u003cspan address=\"10.14309/ajg.0000000000003360\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBordillon P, Pioche M, Wallenhorst Tetal. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc. 2021;94:333\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.gie.2021.01.036\u003c/span\u003e\u003cspan address=\"10.1016/j.gie.2021.01.036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Early colorectal cancer, Bleeding, Endoscopic submucosal dissection","lastPublishedDoi":"10.21203/rs.3.rs-7966824/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7966824/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To analyze the incidence and independent risk factors of postoperative bleeding in patients with early colorectal cancer (ECRC) after endoscopic submucosal dissection (ESD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted a retrospective analysis of 446 ECRC patients who underwent ESD at our institution between January 2019 and December 2023. Patients were categorized into a bleeding group (n=27) and a non-bleeding group (n=419) based on the occurrence of postoperative bleeding. The bleeding rate was calculated, and multivariate logistic regression was employed to identify independent risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Post-ESD bleeding occurred in 27 of the 446 patients, yielding a bleeding rate of 6.05%. Multivariate logistic regression analysis identified hypertension (OR=1.952), lesion size ≥30mm (OR=2.210), and operation time ≥40 minutes (OR=2.022) as independent risk factors for postoperative bleeding (all P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The incidence of bleeding after ESD for early colorectal cancer was 6.05%. Independent risk factors included hypertension, large lesions (≥30mm), and prolonged operation time (≥40 min). Targeted interventions for patients with these characteristics may help reduce the risk of post-ESD bleeding.\u003c/p\u003e","manuscriptTitle":"Unraveling Factors Associated with Post-ESD Bleeding in Early Colorectal Cancer: A Retrospective Analysis of 446 Cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 07:07:00","doi":"10.21203/rs.3.rs-7966824/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27b5ba17-7d15-4180-8ddc-6121d7b3f48f","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-04T11:55:36+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T12:09:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 07:07:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7966824","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7966824","identity":"rs-7966824","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}