title: Endoscopic Doppler US for the prevention of ulcer bleeding after endoscopic submucosal dissection for early gastric cancer: a preliminary study (with video).
abstract: BACKGROUND
  After endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), delayed bleeding occurs in 1.7% to 38% of cases. Routine coagulation of all nonbleeding visible vessels (NBVVs) in post-ESD ulcers is currently performed as standard practice, but it cannot eliminate bleeding. An endoscopic Doppler US (DOP-US) probe system has possible benefits for the prediction of recurrent bleeding in peptic ulcer hemorrhage.
  
  
  OBJECTIVE
  To establish optimum use and evaluate feasibility of DOP-US for post-ESD ulcers.
  
  
  METHODS
  Case series study.
  
  
  METHODS
  Cancer referral center.
  
  
  METHODS
  Eight patients with mucosal EGC larger than 2 cm without ulceration or scarring and 2 patients with EGC less than 3 cm with scarring.
  
  
  METHODS
  We searched for a positive DOP-US signal (DOP-US+), which was defined as pulsatile sound at a depth of 1.5 mm, and NBVVs or areas with DOP-US+ were coagulated with hemostatic forceps. A multibending, double-channel videoendoscope that was fitted with a transparent hood was used.
  
  
  METHODS
  Detectability of DOP-US signals in post-ESD ulcers.
  
  
  RESULTS
  One of 13 oozing bleeding sites, 24 (18%) of 136 NBVVs, and 7 areas without any bleeding stigmata had DOP-US+ and were coagulated until the signal became silent. One hundred twelve NBVVs (82%) and 8 adherent clots without DOP-US signals were left untreated. No delayed bleeding was experienced at 30 days. Median time required for Doppler examination was 34 minutes, but it improved to 18 and 19 minutes in patients 9 and 10, respectively.
  
  
  CONCLUSIONS
  DOP-US might be helpful in the endoscopic management of post-ESD ulcers in EGC. Our setting and maneuver warrant further investigation to clarify whether DOP-US can reduce delayed bleeding and avoid unnecessary coagulation for NBVVs in post-ESD ulcers.
authors.affiliation: Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Noriya
authors.initials: N
authors.lastname: Uedo
authors.forename: Yoji
authors.initials: Y
authors.lastname: Takeuchi
authors.forename: Ryu
authors.initials: R
authors.lastname: Ishihara
authors.forename: Noboru
authors.initials: N
authors.lastname: Hanaoka
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Takashi
authors.initials: T
authors.lastname: Kizu
authors.forename: Koji
authors.initials: K
authors.lastname: Higashino
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iishi
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tatsuta
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.forename: Richard C K
authors.initials: RC
authors.lastname: Wong
mesh_terms: D017115:Catheter Ablation / Q000379:methods; D004210:Dissection / Q000009:adverse effects*; D042241:Early Diagnosis; D019160:Endosonography / Q000295:instrumentation*; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013276:Stomach Ulcer / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000295:instrumentation*; D014741:Video Recording