With the development of endoscopic technologies, the detection rate of early gastric cancer (EGC) and precancerous lesions is gradually increasing. As an effective minimally invasive therapy, endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for EGC and dysplasia. However, postprocedural bleeding is one of the most common complications of ESD, with a reported incidence of 5.1%. Moreover, the effect of continued low-dose aspirin (LDA) on bleeding during the peri-ESD period is not clear.


We searched the OVID/Medline and Google Scholar databases through June 2021 to find studies relating to continued LDA use in patients undergoing ESD. Studies reporting bleeding rates in patients undergoing ESD with and without continued LDA were included. Postoperative bleeding rates were compared between those who continued LDA during the procedure and those who did not; a random-effects model was used to calculate pooled odds ratio for bleeding risk with continued LDA use. A p-value < 0.05 was considered statistically significant.


The initial search identified 2023 studies; after excluding duplicates, review articles, and studies not meeting inclusion criteria, 9 studies (all were retrospective observational studies) were finally included in the analysis. The total number of patients undergoing ESD procedure was 7978, out of which 703 continued LDA during the procedure. Pooled analysis comparing the post-operative bleeding rates between people with and without continued use of LDA revealed that aspirin use during ESD translated into higher postoperative bleeding rates compared to those who did not. (Pooled OR 1.720 , 95%CI: 1.121-2.641, P= 0.01). No interstudy heterogeneity was observed (I2=0).


The results of our meta-analysis demonstrated that LDA continuation significantly increased the risk of post-ESD bleeding. Therefore, the physicians should individualize the decision of continuing LDA in patients undergoing ESD based on their thrombotic risk.

Document Type


Publication Date


Publication Title

The American Journal of Gastroenterology