Gut Liver.  2014 Sep;8(5):480-486. 10.5009/gnl13226.

The Need for Second-Look Endoscopy to Prevent Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Neoplasms: A Prospective Randomized Trial

• Kim JS
• Chung MW
• Chung CY
• Park HC
• Ryang DY
• Myung DS
• Cho SB
• Lee WS
• Joo YE

• KMID: 2070057
• DOI: http://doi.org/10.5009/gnl13226

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.

Keyword

Hemostasis, endoscopic; Hemorrhage; Gastric neoplasms; Endoscopic resection

MeSH Terms

Aged
Dissection/*adverse effects
Female
Gastric Mucosa/*surgery
*Gastroscopy
Humans
Male
Middle Aged
Postoperative Hemorrhage/*prevention & control
Prospective Studies
Risk Factors
*Second-Look Surgery
Single-Blind Method
Stomach Neoplasms/complications/*surgery
Time Factors