Preventing and controlling bleeding in gastric endoscopic submucosal dissection

Chan Hyuk Park, Sang Kil Lee

Research output: Contribution to journalReview articlepeer-review

33 Citations (Scopus)


Although techniques and instruments for endoscopic submucosal dissection (ESD) have improved, bleeding is still the most common complication. Minimizing the occurrence of bleeding is important because blood can interfere with subsequent procedures. Generally, ESD-related bleeding can be divided into intraprocedural and postprocedural bleedings. Postprocedural bleeding can be further classified into early post-ESD bleeding which occurs within 48 hours after ESD and late post-ESD bleeding which occurs later than 48 hours after ESD. A basic principle for avoiding intraprocedural bleeding is to watch for vessels and coagulate them before cutting. Several countertraction devices have been designed to minimize intraprocedural bleeding. Methods for reducing postprocedural bleeding include administration of proton-pump inhibitors or prophylactic coagulation after ESD. Medical adhesive spray such as n-butyl-2-cyano-acrylate is also an option for preventing postprocedural bleeding. Various endoscopic treatment modalities are used for both intraprocedural and postprocedural bleeding. However, hemoclipping is infrequently used during ESD because the clips interfere with subsequent resection. Bleeding that occurs as a result of ESD can usually be managed easily. Nonetheless, more effective ways to prevent bleeding, including reliable ESD techniques, must be developed.

Original languageEnglish
Pages (from-to)456-462
Number of pages7
JournalClinical Endoscopy
Issue number5
Publication statusPublished - 2013 Sept

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology


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