Prediction of intraoperative bleeding during endoscopic treatment in patients with early gastric cancers: Utility of contrast-enhanced MDCT gastrography and the wall-carving image technique

Purpose: To assess the ability of the "wall-carving image (WC) technique," which uses vascular images from computed tomography (CT) gastrography, to predict bleeding during endoscopic treatment in patients with early gastric cancers (EGC). Materials and methods: We analyzed the CT enhancement on WC images of 30 patients with EGC who were treated with endoscopic submucosal dissection (ESD). Patients were divided into two groups - a no-bleeding group and a bleeding group - according to the degree of intraoperative bleeding during the ESD. Patient-related variables (age and sex), lesion-related variables (size, location, and morphological type), a procedure-related variable (procedure time), and the CT enhancement on WC images were compared between two groups. To assess the diagnostic performance of the CT findings in the prediction of intraoperative bleeding, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Lesion location, procedure time, and CT enhancement were all significantly associated with intraoperative bleeding, with p values of 0.046, 0.0007, and 0.0011, respectively. With a cut-off value of 4 or greater indicating positivity for contrast enhancement, the sensitivity, specificity, PPV, and NPV for predicting intraoperative bleeding were 64.3, 93.8, 90.0, and 75.0 %, respectively. Conclusions: Contrast enhancement of WC was significantly associated with intraoperative bleeding during ESD.