A second-look endoscopy after endoscopic submucosal dissection for gastric epithelial neoplasm may be unnecessary: a retrospective analysis of postendoscopic submucosal dissection bleeding
Received 22 April 2009; accepted 27 August 2009. published online 18 November 2009.
Background
Endoscopic submucosal dissection (ESD) is one of the curative endoluminal surgical procedures for gastric epithelial neoplasms. There has been little research on bleeding after gastric ESD.
Objective
To investigate cases of post-ESD bleeding and to verify whether a second-look endoscopy after ESD is effective in the prevention of delayed bleeding.
Design
A retrospective study with consecutive data.
Setting
A single tertiary referral center.
Subjects
A total of 454 gastric epithelial neoplasms (386 early gastric cancers and 68 gastric adenomas).
Interventions
ESD and second-look endoscopy.
Main Outcome Measurements
Predictors on post-ESD bleeding by univariate analysis, incidence of post–ESD bleedings, and the timing of those before and after second-look endoscopy.
Results
Post–ESD bleeding occurred in 26 (5.7%) lesions. Gross type (flat or depressed type) was the only factor influencing post-ESD bleeding. All cases of post-ESD bleeding occurred within 14 days after ESD (median 2; range 0-14), and bleeding tended to occur from the lower and upper stomach earlier and later, respectively. In 19 lesions with delayed bleeding more than 24 hours after ESD, the maximum delayed bleeding rates before and after the second-look endoscopy were 2.8% and 2.5%, respectively.
Limitations
A retrospective, single-center analysis.
Conclusions
A second-look endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding.
Current affiliations: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Reprint requests: Mitsuhiro Fujishiro, MD, PhD, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr. Fujishiro at mtfujish-kkr@umin.ac.jp.
ABSTRACT