The Need for Second-Look Endoscopy to Prevent Delayed Bleeding after Endoscopic Submucosal Dissection for Gastric Neoplasms: A Prospective Randomized Trial
Gut and Liver 2014³â 8±Ç 5È£ p.480 ~ p.486
±èÁ¾¼±(Kim Jong-Sun) - Chonnam National University Medical School Department of Internal Medicine
Á¤¹Î¿ì(Chung Min-Woo) - Chonnam National University Medical School Department of Internal Medicine
Á¤Á¶À±(Chung Cho-Yun) - Chonnam National University Medical School Department of Internal Medicine
¹ÚÇüö(Park Hyung-Chul) - Chonnam National University Medical School Department of Internal Medicine
¾ç´ë¿(Ryang Dae-Yeul) - Chonnam National University Medical School Department of Internal Medicine
¸í´ë¼º(Myung Dae-Seong) - Chonnam National University Medical School Department of Internal Medicine
Á¶¼º¹ü(Cho Sung-Bum) - Chonnam National University Medical School Department of Internal Medicine
À̿ϽÄ(Lee Wan-Sik) - Chonnam National University Medical School Department of Internal Medicine
ÁÖ¿µÀº(Joo Young-Eun) - Chonnam National University Medical School Department of Internal Medicine
Abstract
Background/Aims:Many authors recommend performing a second-look endoscopy (SLE) to reduce the frequency of delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms, but these recommendations have been made despite a lack of reliable evidence supporting the effectiveness of SLE.
Methods:From January 2012 to May 2013, we investigated 441 gastric neoplasms treated by ESD to assess the risk factors for delayed bleeding. Delayed bleeding occurred in four of these lesions within 1 postoperation day. Therefore, we enrolled the patients with the remaining 437 lesions to determine the utility of SLE performed on the morning of postoperative day 2. All lesions were randomly assigned to SLE (220 lesions) groups or non-SLE (217 lesions) groups.
Results:Delayed bleeding occurred in 18 lesions (4.1%). A large tumor size (>20 mm) was the only independent risk factor for delayed bleeding (p=0.007). The chance of delayed bleeding was not significantly different between the patients receiving a SLE (eight cases) and those patients not receiving a SLE (six cases, p=0.787). Furthermore, SLE for lesions with a large tumor size did not significantly decrease delayed bleeding (p=0.670).
Conclusions:SLE had little or no influence on the prevention of delayed bleeding, irrespective of the risk factors.
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Hemostasis, endoscopic, Hemorrhage, Gastric neoplasms, Endoscopic resection
KMID :
1188320140080050480
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The chance of delayed bleeding was not significantly different between the patients receiving a SLE (eight cases) and those patients not receiving a SLE (six cases, p=0.787).