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

BMC Gastroenterology

Research Article

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

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

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

DOI  :  10.1186/1471-230X-14-152

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

来源: Springer

【 摘 要 】

BackgroundGastric 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.MethodsA 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.ResultsPost-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).ConclusionsThe results of this study suggest that second-look endoscopy after gastric ESD may not be useful for preventing postoperative bleeding.

【 授权许可】

Unknown   
© Takahashi et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.