To evaluate the intraoperative bleeding grading, significance and probe the risk factors of ESD treatment for early gastric cancer.

A retrospective analysis was performed on data of early gastric cancer cases that underwent ESD at the Digestive Endoscopy Center of the First Affiliated Hospital of Zhejiang University from January 2012 to December 2018. The intraoperative hemorrhage classification (J0-3) was used to evaluate the bleeding characteristics during ESD operation. The differences in ESD completion between J0-2 and J3 groups were compared and Logistic regression models were used to analyze the risk factors of J3.

A total of 231 patients were included and J0-2 cases accounted for 83.1%. Three patients in the J3 group did not complete the ESD operation and the J0-2 group had no uncompleted cases. Compared with the J0-2 group, J3 group had lower complete resection rate (52.8% vs 86.5%, P<0.01), but higher additional surgery rate (25% vs 10.9%, P=0.03). Univariate Logistic regression analysis showed that the gastric horn, body, and cardia-fundus lesions, infiltrated into the mucosal muscle layer and below, moderate-low differentiated carcinoma was a risk factor for J3. Multivariate Logistic regression showed that gastric horn, body and cardia-fundus lesions were independent predictors of J3.

The intraoperative hemorrhage grade of ESD treatment for early gastric cancer is usually J0-2 grade. When the intraoperative hemorrhage grade reaches J3, the complete resection rate of ESD will be reduced and the additional operation rate will be increased. The non-antrum gastric lesion is an independent predictor of J3 occurrence.