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

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.