The need for second-look endoscopy to prevent delayed bleeding after endoscopic submucosal dissection for gastric neoplasms: a prospective randomized trial

Jong Sun Kim, Min Woo Chung, Cho Yun Chung, Hyung Chul Park, Dae Yeul Ryang, Dae Seong Myung, Sung Bum Cho, Wan Sik Lee, Young Eun Joo, Jong Sun Kim, Min Woo Chung, Cho Yun Chung, Hyung Chul Park, Dae Yeul Ryang, Dae Seong Myung, Sung Bum Cho, Wan Sik Lee, Young Eun Joo

Abstract

Background/aims: Many authors recommend performing a second-look endoscopy (SLE) to reduce the frequency of delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms, but these recommendations have been made despite a lack of reliable evidence supporting the effectiveness of SLE.

Methods: From January 2012 to May 2013, we investigated 441 gastric neoplasms treated by ESD to assess the risk factors for delayed bleeding. Delayed bleeding occurred in four of these lesions within 1 postoperation day. Therefore, we enrolled the patients with the remaining 437 lesions to determine the utility of SLE performed on the morning of postoperative day 2. All lesions were randomly assigned to SLE (220 lesions) groups or non-SLE (217 lesions) groups.

Results: Delayed bleeding occurred in 18 lesions (4.1%). A large tumor size (>20 mm) was the only independent risk factor for delayed bleeding (p=0.007). The chance of delayed bleeding was not significantly different between the patients receiving a SLE (eight cases) and those patients not receiving a SLE (six cases, p=0.787). Furthermore, SLE for lesions with a large tumor size did not significantly decrease delayed bleeding (p=0.670).

Conclusions: SLE had little or no influence on the prevention of delayed bleeding, irrespective of the risk factors.

Keywords: Endoscopic resection; Gastric neoplasms; Hemorrhage; Hemostasis; endoscopic.

Figures

Fig. 1
Fig. 1
The study design. POD, postoperative day; ESD, endoscopic submucosal dissection; WF, water feeding.
Fig. 2
Fig. 2
A flowchart of the allocation of the enrolled gastric neoplasms. ESD, endoscopic submucosal dissection; SLE, second-look endoscopy.

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