Gut Liver.  2015 Jan;9(1):43-51. 10.5009/gnl13252.

Second-Look Endoscopy after Gastric Endoscopic Submucosal Dissection for Reducing Delayed Postoperative Bleeding

• Park CH
• Park JC
• Lee H
• Shin SK
• Lee SK
• Lee YC

• KMID: 2380781
• DOI: http://doi.org/10.5009/gnl13252

Abstract

BACKGROUND/AIMS
This stuy evaluated the role of a second-look endoscopy after gastric endoscopic submucosal dissection in patients without signs of bleeding.
METHODS
Between March 2011 and March 2012, 407 patients with gastric neoplasms who underwent endoscopic submucosal dissection for 445 lesions were retrospectively reviewed. After the patients had undergone endoscopic submucosal dissection, they were allocated to two groups (with or without second-look endoscopy) according to the following endoscopy. The postoperative bleeding risk of the lesions was not considered when allocating the patients.
RESULTS
The delayed postoperative bleeding rates did not differ between the two groups (with vs without second-look endoscopy, 3.0% vs 2.1%; p=0.546). However, a tumor in the upper-third of the stomach (odds ratio [OR], 5.353; 95% confidence interval [CI], 1.075 to 26.650) and specimen size greater than 40 mm (OR, 4.794; 95% CI, 1.307 to 17.588) were both independent risk factors for delayed postoperative bleeding. Additionally, second-look endoscopy was not related to reduced delayed postoperative bleeding. However, delayed postoperative bleeding in the patients who did not undergo a second-look endoscopy occurred significantly earlier than that in patients who underwent a second-look endoscopy (4.5 and 14.0 days, respectively, p=0.022).
CONCLUSIONS
A routine second-look endoscopy after gastric endoscopic submucosal dissection is not necessary for all patients.

Keyword

Second-look endoscopy; Endoscopic submucosal dissection; Bleeding; Delayed bleeding; Hemostasis

MeSH Terms

Female
Gastrectomy/*adverse effects
Gastric Mucosa/surgery
*Gastroscopy
Humans
Male
Middle Aged
Postoperative Hemorrhage/diagnosis/etiology/*prevention & control
Retrospective Studies
Risk Factors
Second-Look Surgery
Stomach/pathology/surgery
Stomach Neoplasms/pathology/surgery
Time Factors