Is a Second-Look Endoscopy Necessary after Endoscopic Submucosal Dissection for Gastric Neoplasm?
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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.
Abstract
Background/Aims: Second-look endoscopy is performedto check for the possibility of post-endoscopic submucosaldissection (ESD) bleeding and to perform prophylactic hemostasisin most hospitals; however, there is little evidenceabout the efficacy of second-look endoscopy. We investigatedwhether second-look endoscopy after ESD is useful inthe prevention of post-ESD bleeding. Methods: A total of 550lesions with gastric epithelial neoplasms in 502 patients(372 men and 130 women) were treated with ESD betweenAugust 18, 2009 and August 18, 2010. After the exclusion ofthree 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 occurrencerate of delayed post-ESD bleeding was not significantly differentbetween the second-look group and the no second-lookgroup (1% vs 2.5%, p>0.05). The only predictor of delayedbleeding was tumor size, regardless of second-look endoscopyafter ESD (22.8±9.87 vs 15.1±10.47, p<0.05). Therewas no difference between the prophylactic hemostasisand nonprophylactic hemostasis groups, including the occurrencerate of delayed bleeding. In the second-look groupwith prophylactic hemostasis, the hospital stay was moreprolonged than in the second-look group without prophylactichemostasis, but there was no significant difference (p=0.08). Conclusions: Second-look endoscopy to prevent delayedbleeding after ESD provides no significant medical benefits.
참고문헌 (24)
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