Scholarlink

Background <p>Whether <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection increases the risk of intraoperative bleeding during endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains controversial. Previous studies often used a binary <i>H. pylori</i> classification and often inadequately controlled for local lesion characteristics, location, size, and invasion depth. This study aimed to re-evaluate the predictive value of <i>H. pylori</i> infection status through refined stratification and systematic adjustment of local factors.</p> Methods <p>This retrospective cohort study consecutively enrolled 799 EGC patients. Based on histological, serological, urea breath test, and endoscopic findings, patients were categorized into three groups: <i>H. pylori</i>-negative (<i>n</i> = 179), prior infection (evidence of prior infection without current activity, <i>n</i> = 454), and active infection (positive histology or urea breath test, <i>n</i> = 166). The primary outcome was intraoperative bleeding requiring active intervention. Multivariate logistic regression models were constructed, incorporating local lesion characteristics and key clinical factors. Interaction, subgroup, and sensitivity analyses were performed to verify the robustness of the findings.</p> Results <p>No significant difference in intraoperative bleeding rates was observed among the three groups (28.5 vs. 26.7 vs. 24.7%, <i>P</i> = 0.728). Multivariate analysis identified larger lesion size and submucosal invasion as independent risk factors. A potential association with dual antiplatelet interruption was noted but based on only four events. Higher platelet count and lesion location in the lower third of the stomach were protective factors. <i>H. pylori</i> infection status was not independently associated with bleeding risk. Interaction, subgroup, and sensitivity analyses consistently supported this conclusion.</p> Conclusion <p>In this large-sample study with rigorous adjustment for confounding factors, <i>H. pylori</i> infection status was not an independent risk factor for intraoperative ESD bleeding. Our findings suggest that risk assessment should prioritize local lesion characteristics and key clinical factors over <i>H. pylori</i> infection status. This hypothesis-generating observation awaits validation in prospective multicenter studies.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Local lesion characteristics rather than H. pylori infection status predict endoscopic submucosal dissection bleeding: a large, confounder-adjusted study and a revised perspective

  • 期刊论文

  • 发表日期：

    2026年7月9日

查看全文
  • Danping Jiang,
  • Kaier Gu,
  • Tianer Gu,
  • Yang Liu,
  • Wei Xie,
  • Saisai Lu

摘要

Background

Whether Helicobacter pylori (H. pylori) infection increases the risk of intraoperative bleeding during endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains controversial. Previous studies often used a binary H. pylori classification and often inadequately controlled for local lesion characteristics, location, size, and invasion depth. This study aimed to re-evaluate the predictive value of H. pylori infection status through refined stratification and systematic adjustment of local factors.

Methods

This retrospective cohort study consecutively enrolled 799 EGC patients. Based on histological, serological, urea breath test, and endoscopic findings, patients were categorized into three groups: H. pylori-negative (n = 179), prior infection (evidence of prior infection without current activity, n = 454), and active infection (positive histology or urea breath test, n = 166). The primary outcome was intraoperative bleeding requiring active intervention. Multivariate logistic regression models were constructed, incorporating local lesion characteristics and key clinical factors. Interaction, subgroup, and sensitivity analyses were performed to verify the robustness of the findings.

Results

No significant difference in intraoperative bleeding rates was observed among the three groups (28.5 vs. 26.7 vs. 24.7%, P = 0.728). Multivariate analysis identified larger lesion size and submucosal invasion as independent risk factors. A potential association with dual antiplatelet interruption was noted but based on only four events. Higher platelet count and lesion location in the lower third of the stomach were protective factors. H. pylori infection status was not independently associated with bleeding risk. Interaction, subgroup, and sensitivity analyses consistently supported this conclusion.

Conclusion

In this large-sample study with rigorous adjustment for confounding factors, H. pylori infection status was not an independent risk factor for intraoperative ESD bleeding. Our findings suggest that risk assessment should prioritize local lesion characteristics and key clinical factors over H. pylori infection status. This hypothesis-generating observation awaits validation in prospective multicenter studies.