Endoscopic submucosal dissection (ESD) is a widely accepted treatment modality for early gastric cancers and adenomas, but is often accompanied by post-ESD bleeding. Herein, we evaluated the association of elevated blood urea nitrogen (BUN) levels at 24 hours after ESD for post-procedural bleeding. Further, we assessed whether an increase in BUN level is associated with an artificial gastric ulcer of high-risk Forrest classification during second-look endoscopy (SLE) after ESD.

We analyzed the data patients who underwent ESD for either early gastric cancer or gastric adenoma. Baseline characteristics, endoscopic findings, and blood test results were assessed for each enrolled patient.

A total of 424 patients were assessed in this study. SLE performed one day after ESD demonstrated 44 post-ESD lesions with a high risk of bleeding and 385 lesions with a low risk of bleeding according to the Forrest classification. An artificial gastric ulcer of high-risk Forrest classification was associated with a significantly higher rate of post-ESD bleeding. An elevated BUN level at 24 hours after ESD was significantly associated with an artificial gastric ulcer of high-risk Forrest classification during SLE. (p=0.003)

Significant changes in BUN levels after ESD suggest the development of post-ESD bleeding. Furthermore, this marker is easy to measure, and enables the early identification of patients with high-risk Forrest classification ulcers, ultimately helping to predict post-ESD bleeding.