A second-look endoscopy may not reduce the bleeding after endoscopic submucosal dissection for gastric epithelial neoplasm

BMC Gastroenterology

Hideyuki Hiraishi¹  Hironori Masuyama¹  Takako Sasai¹  Keiichi Tominaga¹  Kohei Tsuchida¹  Chieko Tsuchida¹  Masakazu Nakano¹  Hitoshi Kino¹  Takashi Akima¹  Naoto Yoshitake¹  Fumiaki Takahashi¹ 

[1] Department of Gastroenterology, Dokkyo Medical University, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan

关键词: Second-look endoscopy;    Endoscopic submucosal dissection;    Gastric neoplasm;    Postoperative bleeding;   

Others  :  1234401
DOI  :  10.1186/1471-230X-14-152

 received in 2014-03-01, accepted in 2014-08-08,  发布年份 2014

【 摘 要 】

Background

Gastric endoscopic submucosal dissection (ESD) has gradually come to be recommended as the optimal treatment for early gastric cancer; however, one of the primary issues is postoperative bleeding. Although second-look endoscopy is conventionally performed to reduce the risk of postoperative bleeding, its benefit has not yet been clearly elucidated. The objective of this study was to elucidate the benefit of second-look endoscopy.

Methods

A total of 459 lesions in patients were underwent gastric ESD from May 2004 to April 2013 at our hospital were included in the analysis. The patients were divided into those who had bleeding within 24 hours after ESD (immediate bleeding) and those in whom bleeding occurred 24 hours or more after the procedure (delayed bleeding); the underlying disease, age, lesion site, diameter of the resected specimen, and lesion diameter were analyzed to identify the risk factors for postoperative bleeding after ESD.

Results

Post-ESD immediate or delayed bleeding occurred in 23 of the 459 cases (5.0%). Second-look endoscopy was performed in 210 of 447 cases (47.0%) excluding 12 cases with immediate bleeding; in the remaining 237 of the 447 cases (53.0%), it was not performed. Post-ESD delayed bleeding occurred in 6 of the 210 cases (2.9%) and 5 of the 237 cases (2.1%), with no statistically significant difference between the two groups. Overall, the following factors were identified as the risk factors for postoperative bleeding: young age (P = 0.005), lesions in the L segment (P = 0.042), and large size of the resected specimen (P = 0.005). The risk factors identified in the immediate bleeding group were lesions in the L segment (P = 0.032), large size of the resected specimen (P < 0.001), and large tumor size (P = 0.011), and those in the delayed bleeding group were young age (P = 0.013) and concomitant renal disease (P = 0.011).

Conclusions

The results of this study suggest that second-look endoscopy after gastric ESD may not be useful for preventing postoperative bleeding.

【 授权许可】

   
2014 Takahashi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S: Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001, 48(2):225-229.
• [2]Oda I, Gotoda T, Hamanaka H, Eguchi T, Saito Y, Matsuda T, Bhandari P, Emura F, Saito D, Ono H: Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive series. Dig Endosc 2005, 17(1):54-58.
• [3]Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K: Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006, 64(6):877-883.
• [4]Watanabe K, Ogata S, Kawazoe S, Watanabe K, Koyama T, Kajiwara T, Shimoda Y, Takase Y, Irie K, Mizuguchi M, Tsunada S, Iwakiri R, Fujimoto K: Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc 2006, 63(6):776-782.
• [5]Higashiyama M, Oka S, Tanaka S, Sanomura Y, Imagawa H, Shishido T, Yoshida S, Chayama K: Risk factors for bleeding after endoscopic submucosal dissection of gastric epithelial neoplasm. Dig Endosc 2011, 23(4):290-295.
• [6]Goto O, Fujishiro M, Oda I, Kakushima N, Yamamoto Y, Tsuji Y, Ohata K, Fujiwara T, Fujiwara J, Ishii N, Yokoi C, Miyamoto S, Itoh T, Morishita S, Gotoda T, Koike K: A multicenter survey of the management after gastric endoscopic submucosal dissection related to postoperative bleeding. Dig Dis Sci 2012, 57(2):435-439.
• [7]Villanueva C, Balanzó J, Torras X, Soriano G, Sáinz S, Vilardell F: Value of second-look endoscopy after injection therapy for bleeding peptic ulcer: a prospective and randomized trial. Gastrointest Endosc 1994, 40(1):34-39.
• [8]Saeed ZA, Cole RA, Ramirez FC, Schneider FE, Hepps KS, Graham DY: Endoscopic retreatment after successful initial hemostasis prevents ulcer rebleeding: a prospective randomized trial. Endoscopy 1996, 28(3):288-294.
• [9]Chiu PW, Lam CY, Lee SW, Kwong KH, Lam SH, Lee DT, Kwok SP: Effect of scheduled second therapeutic endoscopy on peptic ulcer rebleeding: a prospective randomised trial. Gut 2003, 52(10):1403-1407.
• [10]Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y: Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000, 3(4):219-225.
• [11]Hirasawa T, Gotoda T, Miyata S, Kato Y, Shimoda T, Taniguchi H, Fujisaki J, Sano T, Yamaguchi T: Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 2009, 12(3):148-152.
• [12]Pantoflickova D, Dorta G, Ravic M, Jornod P, Blum AL: Acid inhibition on the first day of dosing: comparison of four proton pump inhibitors. Aliment Pharmacol Ther 2003, 17(12):1507-1514.
• [13]Uedo N, Takeuchi Y, Yamada T, Ishihara R, Ogiyama H, Yamamoto S, Kato M, Tatsumi K, Masuda E, Tamai C, Yamamoto S, Higashino K, Iishi H, Tatsuta M: 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 2007, 102(8):1610-1616.
• [14]Kiriyama S, Gotoda T, Sano H, Oda I, Nishimoto F, Hirashima T, Kusano C, Kuwano H: Safe and effective sedation in endoscopic submucosal dissection for early gastric cancer: a randomized comparison between propofol continuous infusion and intermittent midazolam injection. J Gastroenterol 2010, 45(8):831-837.
• [15]Kodashima S, Fujishiro M, Yahagi N, Kakushima N, Omata M: Endoscopic submucosal dissection using flexknife. J Clin Gastroenterol 2006, 40(5):378-384.
• [16]Ono H, Hasuike N, Inui T, Takizawa K, Ikehara H, Yamaguchi Y, Otake Y, Matsubayashi H: Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer. Gastric Cancer 2008, 11(1):47-52.
• [17]Hitomi G, Watanabe H, Tominaga K, Yoshitake N, Suzuki M, Maeda M, Yamagata M, Kanke K, Nakamura T, Masuyama H, Hiraishi H: Endoscopic submucosal dissection in 100 lesions with early gastric carcinoma. Hepatogastroenterology 2009, 56(89):254-260.
• [18]Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, Sugano K: Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 2002, 56(4):507-512.
• [19]Uraoka T, Fujii T, Saito Y, Sumiyoshi T, Emura F, Bhandari P, Matsuda T, Fu KI, Saito D: Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 2005, 61(6):736-740.
• [20]Mukai S, Cho S, Nakamura S, Hatano Y, Kotachi T, Shimizu A, Matsuura G, Azakami T, Takaba A, Hamada T, Hirata K, Nakanishi T: Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD. Surg Endosc 2013, 27(4):1292-1301.
• [21]Kakushima N, Yahagi N, Fujishiro M, Iguchi M, Oka M, Kobayashi K, Hashimoto T, Omata M: The healing process of gastric artificial ulcers after endoscopic submucosal dissection. Dig Endosc 2004, 16(4):327-331.
• [22]Ogoshi K: The management of anticoagulation and antiplatelet therapy for endoscopic procedures. Gastroenterol Endosc 2005, 47(12):2691-2695.
• [23]Kim HH, Park SJ, Park MI, Moon W: Clinical impact of second-look endoscopy after endoscopic submucosal dissection of gastric neoplasms. Gut Liver 2012, 6(3):316-320.
• [24]Goto O, Fujishiro M, Kodashima S, Ono S, Niimi K, Hirano K, Yamamichi N, Koike K: 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 2010, 71(2):241-248.
• [25]Ryu HY, Kim JW, Kim HS, Park HJ, Jeon HK, Park SY, Kim BR, Lang CC, Won SH: 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 2013, 78(2):285-294.
• [26]Li Y, Sha W, Nie Y, Wu H, She Q, Dai S, Jia L, Yu W: Effect of intragastric pH on control of peptic ulcer bleeding. J Gastroenterol Hepatol 2000, 15(2):148-154.
• [27]Tsuji Y, Ohata K, Ito T, Chiba H, Ohya T, Gunji T, Matsuhashi N: Risk factors for bleeding after endoscopic submucosal dissection for gastric lesions. World J Gastroenterol 2010, 16(23):2913-2917.
• [28]Takeuchi T, Ota K, Harada S, Edogawa S, Kojima Y, Tokioka S, Umegaki E, Higuchi K: The postoperative bleeding rate and its risk factors in patients on antithrombotic therapy who undergo gastric endoscopic submucosal dissection. BMC Gastroenterol 2013, 13:136. BioMed Central Full Text
• [29]Okada K, Yamamoto Y, Kasuga A, Omae M, Kubota M, Hirasawa T, Ishiyama A, Chino A, Tsuchida T, Fujisaki J, Nakajima A, Hoshino E, Igarashi M: Risk factors for delayed bleeding after endoscopic submucosal dissection for gastric neoplasm. Surg Endosc 2011, 25(1):98-107.
• [30]Aoyama N, Kinoshita Y, Misaki F, Himeno S, Kasuga M, Chiba T: Evaluation of gastric ulcer healing by lansoprazole by measurement of ulcer diameter. J Clin Gastroenterol 1995, 20(Suppl 2):S86-S89.
• [31]Jang JS, Choi SR, Graham DY, Kwon HC, Kim MC, Jeong JS, Won JJ, Han SY, Noh MH, Lee JH, Lee SW, Baek YH, Kim MJ, Jeong DS, Kim SK: Risk factors for immediate and delayed bleeding associated with endoscopic submucosal dissection of gastric neoplastic lesions. Scand J Gastroenterol 2009, 44(11):1370-1376.
• [32]Cheung J, Yu A, LaBossiere J, Zhu Q, Fedorak RN: Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease. Gastrointest Endosc 2010, 71(1):44-49.
• [33]Uedo N, Takeuchi Y, Ishihara R, Hanaoka N, Inoue T, Kizu T, Higashino K, Iishi H, Tatsuta M, Chak A, Wong RC: Endoscopic Doppler US for the prevention of ulcer bleeding after endoscopic submucosal dissection for early gastric cancer: a preliminary study (with video). Gastrointest Endosc 2010, 72(2):444-448.
• [34]Yoshida Y, Matsuda K, Tamai N, Yoshizawa K, Nikami T, Ishiguro H, Tajiri H: A pilot study using an infrared imaging system in prevention of post-endoscopic submucosal dissection ulcer bleeding. Gastric Cancer 2014, 17(1):116-121.
• [35]Nishiyama N, Mori H, Kobara H, Rafiq K, Fujihara S, Kobayashi M, Oryu M, Masaki T: Efficacy and safety of over-the-scope clip: including complications after endoscopic submucosal dissection. World J Gastroenterol 2013, 19(18):2752-2760.
• [36]Zhang Y, Chen Y, Qu CY, Zhou M, Ni QW, Xu LM: Effects of medical adhesives in prevention of complications after endoscopic submucosal dissection. World J Gastroenterol 2013, 19(17):2704-2708.