Meta-analysis of predictive factors for delayed hemorrhage after endoscopic submucosal dissection in early-stage gastric carcinoma

Table 1 Characteristics of the included studies

Ref.	Study design	Sample size	Total number of lesions	Age (year)	Delayed bleeding (n)	Operation time (min)	Completely resected lesions	Risk factors	Risk factors
Cai et al[10]	Retrospective study	520	520	57.81 ± 10.56	43 (8.27%)	66.78 ± 40.89	508 (97.69%)	Maximum lesion diameter ≥ 3.00 cm, long operation time, Upper area of the stomach	(1)(2)(8)
Nam et al[11]	Retrospective study	1864	1864	68.3 ± 9.3	77 (4.1%)	24.9 ± 17.4	1779 (95.4%)	Upper area of the stomach, Advanced age, History of taking antithrombotic drugs	(2)(3)(4)(5)(8)
Toyokawa et al[12]	Retrospective study	967	1123	69 (58-86)	56 (5.0%)	79.91 ± 45.66	416 (95.33%)	Advanced age, History of taking antithrombotic drugs, Resection size > 40 mm	(2)(3)(4)
Higashiyama et al[13]	Retrospective study	764	924	69.0 ± 9.6	28 (3.0%)	77 ± 63	924 (100%)	Advanced age, History of taking antithrombotic drugs, Hemodialysis	(2)(3)(7)
Hashimoto et al[14]	Retrospective study	489	489	73 (68-78)	11.2% (55/489)	NA	NA	Resection size > 40 mm, Hemodialysis	(5)(6)
Okada et al[15]	Retrospective study	582	647	68.4 ± 9.2	28 (4.33%)	93.7 ± 62.2	607 (93.8%)	Resection size > 40 mm, Hemodialysis	(6)
Sugimoto et al[16]	Retrospective multicenter cohort study	10320	10320	71.7 ± 9.1	485 (4.7%)	18.3	10261	Upper area of the stomach, Advanced age, History of taking antithrombotic drugs	(4)(5)(7)
Mukai et al[17]	Retrospective study	142	161	72.4 ± 8.8	21 (13.0%)	88.2 ± 33.6	NA	Upper area of the stomach, Resection size > 40 mm, Presence of ulcers	(3)(4)(8)
Zhu et al[18]	Retrospective multicenter cohort study	513	513	54.7 (7.9)	23 (4.48%)	19 (82.6)	NA	Upper area of the stomach, Advanced age, History of taking antithrombotic drugs	(2)(4)(6)
Koh et al[19]	Retrospective study	1032	1192	70.3 ± 8.6	62 (5.3)	63.9 ± 51.4	1148 (98.5%)	Advanced age, History of taking antithrombotic drugs, Resection size > 40 mm	(5)(6)(7)
Matsumura et al[20]	Retrospective study	413	425	72.1 ± 8.6	20 (4.7%)	54.1 ± 33.9	95.1%	Advanced age, History of taking antithrombotic drugs, Presence of ulcers	(6)(7)

(1) Maximum lesion diameter ≥ 3.00 cm; (2) Long operation time; (3) Upper area of the stomach; (4) Advanced age; (5) History of taking antithrombotic drugs; (6) Resection size > 40 mm; (7) Hemodialysis; (8) Presence of ulcers.

Table 2 Quality assessment form for the 11 included studies

Ref.	Selection (★/4)	Comparability (★/2)	Outcome (★/3)	Total score (★/9)	Quality level
Cai et al[10]	★★★★	★★	★★★	9	High
Nam et al[11]	★★★★	★★	★★★	9	High
Toyokawa et al[12]	★★★★	★★	★★	8	High
Higashiyama et al[13]	★★★★	★★	★★★	9	High
Hashimoto et al[14]	★★★	★★	★★	7	High
Okada et al[15]	★★★★	★★	★★★	9	High
Sugimoto et al[16]	★★★★	★★	★★★	9	High
Mukai et al[17]	★★★	★	★★	6	Middle
Zhu et al[18]	★★★★	★★	★★★	9	High
Koh et al[19]	★★★★	★★	★★★	9	High
Matsumura et al[20]	★★★★	★★	★★★	9	High

Table 3 Meta-regression results for risk factors of delayed bleeding after endoscopic submucosal dissection

Risk factor	Covariate	β (95%CI)	P value	R² (explained heterogeneity)
Advanced age	Comorbidities	0.22 (0.11-0.33)	0.001	11%
Antithrombotic use	Drug type (aspirin vs clopidogrel)	0.30 (0.18-0.42)	0.001	15%
Resection size > 40 mm	Hemostatic technique	0.18 (0.07-0.29)	0.002	10%

Table 4 Publication bias analysis of Egger’s test

Risk factor	β (95%CI)	P value
Long operation time	0.82 (-0.34-2.00)	0.17
Upper stomach lesions	0.65 (-0.12-1.42)	0.10
Advanced age	0.78 (-0.21-1.77)	0.12
Antithrombotic use	0.91 (0.15-1.67)	0.02
Resection size > 40 mm	0.73 (-0.18-1.64)	0.11
Hemodialysis	0.61 (-0.22-1.44)	0.15
Ulcer presence	0.85 (0.09-1.61)	0.03