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Background: The incidence of gastric neoplasm among elderly patients is rising.At present,endoscopic submucosal dissection (ESD) is a treatment modality of choice for early gastric neoplasm.The most common post-ESD complication is bleeding,which has not been thoroughly investigated in elderly patients in this setting.The aim of this study was to investigate risk factors of post-ESD bleeding in elderly patients with early gastric neoplasm.Methods: This retrospective study included consecutive 431 ESD procedures for early gastric neoplasm in 418 elderly patients (over 60 years old) during the period from January 1,2010 to November 30,2014.Risk factors including age,gender,comorbidity,medication,tumor pathology,resection tissue size,operative time,and operators experience,etc,were compared between the two patient groups with or without post-ESD bleeding.Result: Post-ESD bleeding was identified in 38/431 (8.8%) qualified study cases and significantly associated with: 1) the specimen size larger than 4 cm,compared to that smaller than 4 cm (odds ratio: 2.5;95% Confidence Interval: 1.12-5.58,P=0.026) and 2) operative time longer than 70 minutes,compared to that shorter than 70 minutes (Odds ratio: 2.7;95% Confidence Interval: 1.30-5.80,P=0.008) by multivariate logistic analysis.Conclusions: In elderly patients with the ESD procedure for early gastric neoplasm,the specimen size larger than 4 cm and operative time over 70min were independent risk factors for post-ESD bleeding.