The Need for Second-Look Endoscopy to Prevent Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Neoplasms: A Prospective Randomized Trial
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Background/Aims: Many authors recommend performing asecond-look endoscopy (SLE) to reduce the frequency of delayedbleeding after endoscopic submucosal dissection (ESD)for gastric neoplasms, but these recommendations havebeen made despite a lack of reliable evidence supportingthe effectiveness of SLE. Methods: From January 2012 toMay 2013, we investigated 441 gastric neoplasms treated byESD to assess the risk factors for delayed bleeding. Delayedbleeding occurred in four of these lesions within 1 postoperationday. Therefore, we enrolled the patients with the remaining437 lesions to determine the utility of SLE performedon the morning of postoperative day 2. All lesions wererandomly assigned to SLE (220 lesions) groups or non-SLE(217 lesions) groups. Results: Delayed bleeding occurredin 18 lesions (4.1%). A large tumor size (>20 mm) was theonly independent risk factor for delayed bleeding (p=0.007). The chance of delayed bleeding was not significantly differentbetween the patients receiving a SLE (eight cases) andthose patients not receiving a SLE (six cases, p=0.787). Furthermore, SLE for lesions with a large tumor size did notsignificantly decrease delayed bleeding (p=0.670). Conclusions:SLE had little or no influence on the prevention ofdelayed bleeding, irrespective of the risk factors.
Abstract
Background/Aims: Many authors recommend performing asecond-look endoscopy (SLE) to reduce the frequency of delayedbleeding after endoscopic submucosal dissection (ESD)for gastric neoplasms, but these recommendations havebeen made despite a lack of reliable evidence supportingthe effectiveness of SLE. Methods: From January 2012 toMay 2013, we investigated 441 gastric neoplasms treated byESD to assess the risk factors for delayed bleeding. Delayedbleeding occurred in four of these lesions within 1 postoperationday. Therefore, we enrolled the patients with the remaining437 lesions to determine the utility of SLE performedon the morning of postoperative day 2. All lesions wererandomly assigned to SLE (220 lesions) groups or non-SLE(217 lesions) groups. Results: Delayed bleeding occurredin 18 lesions (4.1%). A large tumor size (>20 mm) was theonly independent risk factor for delayed bleeding (p=0.007). The chance of delayed bleeding was not significantly differentbetween the patients receiving a SLE (eight cases) andthose patients not receiving a SLE (six cases, p=0.787). Furthermore, SLE for lesions with a large tumor size did notsignificantly decrease delayed bleeding (p=0.670). Conclusions:SLE had little or no influence on the prevention ofdelayed bleeding, irrespective of the risk factors.
참고문헌 (25)
- Fujishiro M, "Endoscopic submucosal dissection for gastric cancer", Curr Treat Options Gastroenterol, 11, pp.119~124 (2008)
- Ohkuwa M, "New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife", Endoscopy, 33, pp.221~226 (2001)
- Katsube T, "The efficacy of endoscopic submucosal dissection compared with modified endoscopic aspiration mucosectomy by assessing the short-term therapeutic results for differentiated mucosal gastric cancer", Anticancer Res, 29, pp.4271~4274 (2009)
- Goto O, "A second-look endoscopy after endoscopic submucosal dissection for gastric epithelial neoplasm may be unnecessary: a retrospective analysis of postendoscopic submucosal dissection bleeding", Gastrointest Endosc, 71, pp.241~248 (2010)
- Chung IK, "Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study", Gastrointest Endosc, 69, pp.1228~1235 (2009)
- Nakamura M, "Risk factors for delayed bleeding from endoscopic submucosal dissection of gastric neoplasms", Scand J Gastroenterol, 47, pp.1108~1114 (2012)
- Muraki Y, "Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissection", World J Gastrointest Endosc, 4, pp.1~8 (2012)
- Saeed ZA, "Graham DY. Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial", Endoscopy, 28, pp.288~294 (1996)
- Chiu PW, "Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial", Gut, 52, pp.1403~1407 (2003)
- Lau JY, "Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers", N Engl J Med, 343, pp.310~316 (2000)
- Takizawa K, "Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection: an analysis of risk factors", Endoscopy, 40, pp.179~183 (2008)
- Uedo N, "Effect of a proton pump inhibitor or an H2-receptor antagonist on prevention of bleeding from ulcer after endoscopic submucosal dissection of early gastric cancer: a prospective randomized controlled trial", Am J Gastroenterol, 102, pp.1610~1616 (2007)
- Kim JW, "Risk factors for delayed postendoscopic mucosal resection hemorrhage in patients with gastric tumor", Eur J Gastroenterol Hepatol, 19, pp.409~415 (2007)
- 김형훈, "Clinical Impact of Second-Look Endoscopy after Endoscopic Submucosal Dissection of Gastric Neoplasms", Gut and Liver, 6(3), pp.316~320 (2012), 거트앤리버 발행위원회[DOI]
- Gotoda T, "Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers", Gastric Cancer, 3, pp.219~225 (2000)
- Gotoda T, "Endoscopic submucosal dissection of early gastric cancer", J Gastroenterol, 41, pp.929~942 (2006)
- Ono H, "Endoscopic mucosal resection for treatment of early gastric cancer", Gut, 48, pp.225~229 (2001)
- Kakushima N, "The healing process of gastric artificial ulcers after endoscopic submucosal dissection", Dig Endosc, 16, pp.327~331 (2004)
- Schlemper RJ, "The Vienna classification of gastrointestinal epithelial neoplasia", Gut, 47, pp.251~255 (2000)
- Japanese Gastric Cancer Association, "Japanese classification of gastric carcinoma: 3rd English edition", Gastric Cancer, 14, pp.101~112 (2011)
- Heldwein W, "Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers?", Endoscopy, 21, pp.258~262 (1989)
- Goto O, "Is it possible to predict the procedural time of endoscopic submucosal dissection for early gastric cancer?", J Gastroenterol Hepatol, 24, pp.379~383 (2009)
- Graham DY, "Effect of treatment of Helicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer. A randomized, controlled study", Ann Intern Med, 116, pp.705~708 (1992)
- Kakushima N, "Helicobacter pylori status and the extent of gastric atrophy do not affect ulcer healing after endoscopic submucosal dissection", J Gastroenterol Hepatol, 21, pp.1586~1589 (2006)
- Furuta T, "Influence of CYP2C19 pharmacogenetic polymorphism on proton pump inhibitor-based therapies", Drug Metab Pharmacokinet, 20, pp.153~167 (2005)