Gut Liver.  2015 Jan;9(1):52-58. 10.5009/gnl13422.

Is a Second-Look Endoscopy Necessary after Endoscopic Submucosal Dissection for Gastric Neoplasm?

• Kim ER
• Kim JH
• Kang KJ
• Min BH
• Lee JH
• Rhee PL
• Rhee JC
• Kim JJ

• KMID: 2380782
• DOI: http://doi.org/10.5009/gnl13422

Abstract

BACKGROUND/AIMS
Second-look endoscopy is performed to check for the possibility of post-endoscopic submucosal dissection (ESD) bleeding and to perform prophylactic hemostasis in most hospitals; however, there is little evidence about the efficacy of second-look endoscopy. We investigated whether second-look endoscopy after ESD is useful in the prevention of post-ESD bleeding.
METHODS
A total of 550 lesions with gastric epithelial neoplasms in 502 patients (372 men and 130 women) were treated with ESD between August 18, 2009 and August 18, 2010. After the exclusion of three lesions of post-ESD bleeding within 24 hours, 547 lesions (335 early gastric cancers and 212 gastric adenomas) were included for the final analysis.
RESULTS
The occurrence rate of delayed post-ESD bleeding was not significantly different between the second-look group and the no second-look group (1% vs 2.5%, p>0.05). The only predictor of delayed bleeding was tumor size, regardless of second-look endoscopy after ESD (22.8+/-9.87 vs 15.1+/-10.47, p<0.05). There was no difference between the prophylactic hemostasis and nonprophylactic hemostasis groups, including the occurrence rate of delayed bleeding. In the second-look group with prophylactic hemostasis, the hospital stay was more prolonged than in the second-look group without prophylactic hemostasis, but there was no significant difference (p=0.08).
CONCLUSIONS
Second-look endoscopy to prevent delayed bleeding after ESD provides no significant medical benefits.

Keyword

Second-look endoscopy; Endoscopic submucosal dissection; Delayed bleeding; Prophylactic hemostasis

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Gastrectomy/adverse effects
Gastric Mucosa/surgery
*Gastroscopy
Humans
Length of Stay
Male
Middle Aged
Postoperative Hemorrhage/*diagnosis/etiology
Retrospective Studies
Risk Factors
Second-Look Surgery
Stomach/pathology/surgery
Stomach Neoplasms/pathology/*surgery
Time Factors