Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD. Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed. Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the lowrisk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group. Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.
Abstract
Background/Aims: Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD. Methods: Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed. Results: Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the lowrisk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group. Conclusions: The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.
참고문헌 (24)
- Yamada M, "Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms in 423 cases : a retrospective study", Endoscopy, 49, pp.233~242 (2017)
- Shigita K, "Long-term outcomes after endoscopic submucosal dissection for superficial colorectal tumors", Gastrointest Endosc, 85, pp.546~553 (2017)
- Repici A, "Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia : a systematic review", Endoscopy, 44, pp.137~150 (2012)
- Fuccio L, "Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia : a systematic review and meta-analysis", Gastrointest Endosc, 86, pp.74~86 (2017)
- Young-Hoon Jeong, "Clinicopathological feature and treatment outcome of patients with colorectal laterally spreading tumors treated by endoscopic submucosal dissection", Intestinal research, 17(1), pp.127~134 (2019), 대한장연구학회[DOI]
- Terasaki M, "Risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal neoplasms", Int J Colorectal Dis, 29, pp.877~882 (2014)
- Suzuki S, "Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms", World J Gastroenterol, 20, pp.1839~1845 (2014)
- Bahin FF, "Prophylactic endoscopic coagulation to prevent bleeding after wide-field endoscopic mucosal resection of large sessile colon polyps", Clin Gastroenterol Hepatol, 13, pp.724~730 (2015)
- Kim GU, "Association between the ulcer status and the risk of delayed bleeding after the endoscopic mucosal resection of colon", J Gastroenterol Hepatol, 32, pp.1846~1851 (2017)
- Elliott TR, "Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps", Endoscopy, 50, pp.790~799 (2018)
- Villanueva C, "Value of second-look endoscopy after injection therapy for bleeding peptic ulcer : a prospective and randomized trial", Gastrointest Endosc, 40, pp.34~39 (1994)
- Saeed ZA, "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)
- Ryu HY, "Second-look endoscopy is not associated with better clinical outcomes after gastric endoscopic submucosal dissection : a prospective, randomized, clinical trial analyzed on an as-treated basis", Gastrointest Endosc, 78, pp.285~294 (2013)
- Mochizuki S, "Scheduled second-look endoscopy is not recommended after endoscopic submucosal dissection for gastric neoplasms(the SAFE trial) : a multicentre prospective randomised controlled non-inferiority trial", Gut, 64, pp.397~405 (2015)
- Kim EH, "Role of second-look endoscopy and prophylactic hemostasis after gastric endoscopic submucosal dissection : a systematic review and meta-analysis", J Gastroenterol Hepatol, 32, pp.756~768 (2017)
- Na S, "Delayed bleeding rate according to the forrest classification in second-look endoscopy after endoscopic submucosal dissection", Dig Dis Sci, 60, pp.3108~3117 (2015)
- Tanaka S, "Colorectal endoscopic submucosal dissection : present status and future perspective, including its differentiation from endoscopic mucosal resection", J Gastroenterol, 43, pp.641~651 (2008)
- ASGE Standards of Practice Committee, "Management of antithrombotic agents for endoscopic procedures", Gastrointest Endosc, 70, pp.1060~1070 (2009)
- Hurlstone DP, "Achieving R0 resection in the colorectum using endoscopic submucosal dissection", Br J Surg, 94, pp.1536~1542 (2007)
- 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)
- Yoshida N, "Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications", World J Gastroenterol, 16, pp.1688~1695 (2010)
- Liaquat H, "Prophylactic clip closure reduced the risk of delayed postpolypectomy hemorrhage : experience in 277 clipped large sessile or flat colorectal lesions and 247 control lesions", Gastrointest Endosc, 77, pp.401~407 (2013)
- Fujihara S, "The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection", Oncol Rep, 30, pp.85~90 (2013)