Red blood cell distribution width as a novel marker for predicting bleeding after endoscopic resection for early gastric cancer

Takada Yumemi; Shinji Yoshii; Tsukasa Yamakawa; Yuki Hayashi; Takakazu Miyake; Yoshihiro Yokoyama; Gota Sudo; Kei Mitsuhashi; Masanori Nojima; Hiro-O Yamano; Hiroshi Nakase

doi:10.1002/deo2.123

Red blood cell distribution width as a novel marker for predicting bleeding after endoscopic resection for early gastric cancer

DEN Open. 2022 May 13;3(1):e123. doi: 10.1002/deo2.123. eCollection 2023 Apr.

Authors

Takada Yumemi^{1

2}, Shinji Yoshii¹, Tsukasa Yamakawa¹, Yuki Hayashi¹, Takakazu Miyake¹, Yoshihiro Yokoyama¹, Gota Sudo^{1

2}, Kei Mitsuhashi^{1

3}, Masanori Nojima⁴, Hiro-O Yamano¹, Hiroshi Nakase¹

Affiliations

¹ Department of Gastroenterology and Hepatology Sapporo Medical University School of Medicine Hokkaido Japan.
² Department of Gastroenterology Hakodate Goryokaku Hospital Hokkaido Japan.
³ Department of Gastroenterology TOKEIDAI Memorial Hospital Hokkaido Japan.
⁴ Center for Translational Research The Institute of Medical Science Hospital The University of Tokyo Tokyo Japan.

Abstract

Objectives: Endoscopic resection (ER) is a minimally invasive treatment for early gastric cancer (EGC); however, there is a high occurrence of bleeding. This study aimed to clarify the significance of red blood cell distribution width (RDW) as a predictive risk factor for bleeding after ER for EGC.

Methods: We conducted a retrospective study based on data for patients who underwent ER for EGC from 2019 to 2021. This study included 79 lesions in 54 patients who underwent ER for EGC. The primary outcome was the association between RDW before ER and bleeding within 28 days of treatment. Receiver operating characteristic (ROC) curves were constructed, wherein areas under the curve (AUCs) and 95% confidence intervals were calculated to compare the discriminatory power of RDW for predicting bleeding.

Results: Endoscopic submucosal dissection was used as the resection method for 73 lesions, whereas endoscopic mucosal resection was used for six lesions. En bloc resection was performed in all cases. There were no cases of perforation; however, bleeding after ER occurred in five cases (9.3%). ROC curve analysis of bleeding after ER showed that the AUC was 0.843 with a good diagnostic performance. When the cut-off value of RDW was set at 14.4%, sensitivity and specificity were 80% and 85.7%, respectively. There was a bleeding rate of 36.4% (4/11) at an RDW of ≥14.4%, which was significantly higher than that of 2.3% (1/43) at an RDW of <14.4%.

Conclusion: RDW can be a predictor of bleeding risk after ER for EGC.

Keywords: endoscopic mucosal resection; endoscopic submucosal dissection; gastrointestinal hemorrhage; red cell distribution width; stomach neoplasm.